Introduction Public hospitals, as a primary destination for low-income residents seeking medical care, play a crucial role in our society. Through constant changes in the healthcare system of our nation, these institutions remain true to their mission of caring for disadvantaged populations who lack stable access to health care. Over the past decade, the government experienced increasing difficulty in operating public hospitals due to scant revenue generation and constant budgetary constraints. In 2010, while the average national hospital profit margin was approximately 7%, public hospitals have hovered around 2%, which often resulted in operating at a negative margin when factoring in Medicaid reimbursements.1 These financial shortages are intensifying and hospitals are forced to forgo renovations and routine maintenance to stay solvent. In 1999, one out of four hospitals was public, and by 2010, this number decreased to one out of five2, signifying the growing instability of such institutions. The burden of providing uncompensated care, for which no payment is received from the patient or the insurer, carries an enormous financial liability for public hospitals. Costs of such services have skyrocketed from $3.1 billion to $45.9 billion in the past 30 years.3 As the Patient Protection and Affordable Care Act (PPACA) is implemented to overhaul the delivery of healthcare, uncertainties arise for public hospitals. It is likely that over 32 million people who are expected to gain coverage through PPACA by 2016 will seek care at their local public hospitals.4 Even if some of these patients decide to choose competing private providers, public hospitals must still be prepared for the other 23 million who are expected to remain uninsur... ... middle of paper ... ...ault/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf). 14. Massachusetts Health Reform: Lessons Learned about the Critical Role of Safety Net Health Systems. Washington, DC: National Association of Public Hospitals and Health Systems, April 2009 (http://www.naph.org/publications/MA-health-Reform-Issue-Brief.aspx?FT=.pdf). 15. Ku L, Jones E, Shin P, Byrne FR, Long SK. Safety-net providers after health care reform: lessons from Massachusetts. Arch Intern Med. 2011;171:1379-1384. 16. Ross JS, Bemheim SM, Lin Z, Drye EE, Chen J, et al. Based on key measures, care quality for Medicare enrollees at safety-net and non-safety-net hospitals was almost equal. Health Aff (Millwood). 2012;31:1739-1748. 17. Jha AK, Orav EJ, Li Z, Epstein AM. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167:1177-1182.
Bigger hospitals increasing market share Loss of Medicaid and Medicare reimbursement Decline in revenue Loss of patients
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Supposedly, the national average occupancy rate of hospitals is lower than it should be because of rising costs of hospital care. Factors causing variations in occupancy rates are hospital size, product diversification, and urgent versus non-urgent
Jewelll, N., & Russell, K. (1992). Current health status of african americans. Journal of community health nursing, 9(3), 161-169.
Sommers, B. D., & Epstein, A. M. (2010). Medicaid expansion—the soft underbelly of health care reform. New England Journal of Medicine
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The ability of the Affordable Care Act to mitigate the current pressure of the uninsured on our healthcare system is unknown. Yet, the prediction is that it will greatly reduce the effect on emergency room systems throughout the nation. This reduction will be greater in the south and southwest regions of the United States (The Henry J. Kaiser Family Foundation, 2013 p. 4). The potential is there, however, the willingness of the population is yet to be seen. What does the future hold? Only the future knows.
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
Berman, M. L. (2011). From Health Care Reform to Public Health Reform. Journal of Law, Medicine & Ethics, 39(3), 328-339. doi:10.1111/j.1748-720X.2011.00603.x
Reese, Philip. Public Agenda Foundation. The Health Care Crisis: Containing Costs, Expanding Coverage. New York: McGraw, 2002.
In order to fully understand the uninsured and underinsured problem that hospital administrators face the cause must be examined. The health outcomes of uninsured individuals are generally worse than those who are insured. Uninsured persons are more likely to experience avoidable hospitalizations, diagnosed at later stages of disease, hospitalized on an emergency or urgent basis, and more seriously ill upon hospitalization (Simpson, 2002) Because the uninsured often lack an ongoing relationship with a health-care provider, they are less likely to receive preventive care and diagnostic tests (Kemper, 2002). Many corporations balance their budget through cost cuts and other moves, but have been slammed with an increasing load of uninsured patients, coupled with reduced payments from government and private insurance programs. In 2000, 564,476 uninsured patients came through Health and Hospitals Corporations health care centers, a 30 percent increase from 1996. In the same period, Congress reduced Medicare reimbursements to hospitals, while Medicaid reimbursements to primary care clinics remained basicall...
While the purpose of The Patient Protections and Affordable Care Act is to improve the costs and quality of healthcare for all U.S. citizens and legal immigrants, the PPACA will accomplish this foremost by extending insurance coverage to millions of Americans who are currently without health insurance, as stated in Title I: Quality, Affordable Health Care for All Americans (The Health Foundation of Greater Cincinnati). By having everyone participate in the same health insurance pool, we can ensure a health insurance market that is more affordable for everyone. One of the problems with our health insurance market has been that people have a hard time getting insurance coverage on their own and its very costly and often does not cover a lot. The health refo...
“Medicare and the New Health Care Law — What it Means for You.” (2010). Medicare Publications, http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
Reforming the health care delivery system to progress the quality and value of care is indispensable to addressing the ever-increasing costs, poor quality, and increasing numbers of Americans without health insurance coverage. What is more, reforms should improve access to the right care at the right time in the right setting. They should keep people healthy and prevent common, preventable impediments of illnesses to the greatest extent possible. Thoughtfully assembled reforms would support greater access to health-improving care, in contrast to the current system, which encourages more tests, procedures, and treatments that are either