The Current Status of Health Care Reform

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Health Care Reform is a concern for people that have health insurance, for those that can’t afford health insurance and the price of healthcare for all of us. There are the difference views on Health Care Reform: The healthcare view, the public opinion and The House and the Senate.

The Center for Medicare and Medicaid will withhold 2% of base payments that would serve as incentive payments to hospital based on their total performance score derived from separate domains. The current domains include process measure, outcome and patient satisfaction. The Senate bill also requires a comprehensive review of the hospital wage index. Our cost problems, affect not only the federal budge deficit, but also individual American businesses and household. Only be aligning payment models across public and private systems will we both address federal spending and make the health care system more affordable for all Americans” (The New England Journal of Medicine)

Both House and Senate versions identify “excess payments” based on performance of risk-adjusted re-admissions rates for AMI, Heart Failure and Pneumonia. The Center for Medicaid and Medicare would recoup excess payments by discounting future payments with cuts capped at a certain percentage of total payments. In effort to go beyond “fixing” fee-for service payments, the proposed legislation includes alternative models include bundled payments to cover the range of services related to a defined medical condition: global fees to cover the entire cost of care (regardless of the setting) over an extended period for a person with a condition such as cancer; extra payments for patient-center primary care delivered through medical home; and the rewarding of Accountable Care Organizations for achieving the desired performance in caring for a defined population over the course of the year. (Medicare Payment Advisory Commission. Reforming the delivery system. Report to Congress) (Fisher ES)

For providing episode of care for services provided three days prior to the admission, during the admission and 30 days after discharge. The service would include acute care, physician services provided inside and outside the hospital, outpatient services, post acute care services, including home health, inpatient rehabilitation, long term care hospital and others. Participating organization would required to submit data and specific measure, including measure of functional improvement, rates of avoidable hospitalization, incidence of hospital acquired infections and efficiency. An independent evaluation would review the extent to which the a pilot the selected quality of measures, improved health outcomes, improved beneficiary access to care and reduced Medicare spending.
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