EDITORIAL ADVISORY BOARD: Obamacare is bringing more changes this year

2013-02-10T00:00:00Z EDITORIAL ADVISORY BOARD: Obamacare is bringing more changes this yearBy Seth Warren nwitimes.com
February 10, 2013 12:00 am  • 

More than two years after the Patient Protection and Affordable Care Act was passed, many changes contained in the law will begin to be phased in this year.

We in the health care industry are cautiously optimistic that the reforms proposed in Obamacare will do as promised — provide a safety net for the nation’s most vulnerable populations while improving quality of care and providing additional preventive screenings.

2013 will be a watershed year, a time when health care organizations and government offices that deal with health care gear up for greater changes to be implemented in 2014 and beyond.

This is one of the most massive overhauls of health care since President Ronald Reagan created and implemented a program in the 1980s based on a new notion of reimbursement known as Diagnostic Related Guidelines.

One of the first major reforms of the Medicare system, DRGs mandated that government pay for hospitalizations and doctor visits based on a diagnosis, that the charges be based on the average cost for a patient diagnosed with a specific illness or surgical procedure, such as heart attack, stroke, appendicitis or hip replacement. As has become common in reimbursement, private insurance companies quickly followed the model developed by the government.

When it comes to government-provided health insurance, there are no small numbers. In all, there are about 50 million retirement-age Americans under Medicare, another 31 million children covered by government-sponsored health insurance and 30 million needy adults insured as part of states’ Medicaid health insurance programs.

Each of these populations will be impacted in some way by the implementation of Obamacare, despite the fact they are already covered by health insurance. The fact that those already covered will be impacted is a misunderstood component of the law, which has been seen primarily as a mechanism to guarantee access to health insurance for the uninsured.

For some covered under Medicare, a pilot program will be implemented this year to coordinate patient care. Rather than have each provider billing separately, the program will have hospitals, physicians as well as allied health professionals bundling their bill for services, with compensation paid based on an individual episode of care.

In addition, hospitals and physician practice groups will continue to receive reimbursement based on a program that began last year, one which compensates based on quality of care, rather than the volume of patients seen.

At the same time, health insurance companies that charge what the government considers excessive administrative fees and executive bonuses will be penalized while providers who save Medicare money will be rewarded.

Although we continue to have reservations about some of the components of the law, we are working diligently to implement the new rules while actively participating in the massive overhaul of the system.

Regardless of the impact of Obamacare, we at Franciscan Alliance facilities are steadfast in our commitment to provide high quality, compassionate care to our patients.

Seth Warren is regional CEO of the Franciscan Alliance South Suburban Chicago Region and president of Franciscan St. James Health. The opinions are the writer's.

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