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.
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).
The commonwealth of Massachusetts’ compulsory health care system does make health care mandatory for all its inhabitants, but it cannot provide prima...
Davidson, Stephen M. Still Broken: Understanding the U.S. Health Care System. Stanford, CA: Stanford Business, 2010. Print.
Reese, Philip. Public Agenda Foundation. The Health Care Crisis: Containing Costs, Expanding Coverage. New York: McGraw, 2002.
(W. Lease, personal communication, July 23, 2010), the “unknown” of the recent health care reform legislation is an external influence that is most relevant to our organization, stated by William Lease, senior vice president of clinical support services. Mr. Lease states, that health care reform legislation will impact our organization in many ways; especially after 2014. While more employees will have health insurance coverage and there will be more patients to treat; the need for controlling costs and improving efficiency is i...
Wise, N., & Taylor, F. (n.d.) Moving Forward With Reform: The Health Plan Pulse for 2012 and Beyond. Retrieved January 16, 2012 from
The NHQDR 2012 is a comprehensive report that implies there are changes that need to occur at multiple levels within the health care system and public policy. The report implies that the health care system needs to become more accessible to all populations, and the disparities in quality of care need to decrease. Health care providers need to evaluate access to care, treatment quality and its effectiveness. Meanwhile public policy needs to support funded programs that will improve access to care and support preventative services.
Healthcare reform has been debated throughout history, and continues to be a debate today. An initial healthcare plan was supported by Theodore Roosevelt in 1910. He campaigned on the promise of national healthcare, but he was defeated. Harry Truman proposed it thirty years later but the plan was vigorously opposed by American Medical Association (AMA) as socialized medicine (Palmer, 2010). As a Family Nurse Practitioner (FNP) who has been practicing for more than a year, an advanced nurse with a Master of Science in Administration for ten years, a military nurse leader for twenty years, and a home health and ICU nurse for more than twenty – five years, I agree that we need to rethink the direction of healthcare. Without healthcare reform, the number of uninsured is predicted to increase to 54 million in 2019 according to Deutsche Bank Research trends (2010). This increase in uninsured patients will put a strain on emergency rooms (ERs) as many uninsured patients use ERs as their primary care, which increases healthcare costs and offers poor follow-up care for the patient.
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.
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...
The Consequences Of Obamacare [Electronic Resource] : Impact On Medicaid And State Health Care Reform : Hearing Before The Committee On Energy And Commerce, House Of Representatives, One Hundred Twelfth Congress, First Session, March 1, 2011. n.p.: Washington : U.S. G.P.O., 2011., 2011. Louisiana State University. Web. 18 Apr. 2014.
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
In the healthcare system, quality is a major driving compartment for patient outcomes. The quality of care reflects the outcomes in a patient’s care. According to Feeley, Fly, Walters and Burke (2010), “quality equ...
This study is intended to further understand the impact of health care quality and cost
Barton, P.L. (2010). Understanding the U.S. health services system. (4th ed). Chicago, IL: Health Administration Press.