I’m working on a health & medical discussion question and need support to help me understand better.
Please write a discussion and respond to this 2 peers’ Discussion Prompts
- Identify two features of the Affordable Care Act (ACA) that affect healthcare reimbursement.
- Which one to you think will have the most impact on providers?
- Respond to at least two (2) of your classmates or your instructors posts. Your responses should include elements such as follow-up questions, a further exploration of topics from the initial post, or requests for further clarification or explanation on some points made.
- ALL citations and references needs to be APA 7th edition format. THANK YOU!
When the Affordable Care Act, ACA, was signed into law in March of 2010, one of the main goals was to reduce healthcare costs. Under the ACA, payment systems are linked to provider accountability to reduce costs and improve health outcomes. The ACA puts major emphasis on primary care, making primary care physicians the first line of service for everything (Clarke, 2016). If physicians provide 60% of their services in primary care codes, they are eligible for a bonus (Rapfogel et al., 2020). The bonus to each individual physician is dependent on the care that is provided and the number of Medicare patients they see (Rapfogel et al., 2020). Another feature of the ACA that affects reimbursement is the Hospital Readmission Reduction Program, HRRP. Under the HRRP, Medicare payments to hospitals are reliant on readmission rates of Medicare patients (Boccuti et al., 2017). If the readmission rate of the hospital is higher than the national average, the payments across all Medicare admissions for the hospital will be reduced (Boccuti et al., 2017).
I think the emphasis that the ACA puts on primary care will affect providers the most because reimbursement is directly linked to the care that they provide. For primary care physicians, this emphasis will affect them positively. The ACA pushes patients to primary care providers as the first line of service meaning that these providers will see more patients and will receive greater reimbursement. The ACA also has incentives in place to push aspiring physicians towards primary care like scholarship funding and loan forgiveness programs (Clarke, 2016). But the strong emphasis on primary care negatively affects specialists. With more patients seeing primary care providers as the first line, specialists may see a decline in patients. Sievert (2016) found that 41% of physicians took an additional job because their income decreased after the passage of the ACA.
One feature of the ACA is the Pay for Performance (P4P). It is a reimbursement method for providers that give incentive payments to those providers meeting certain predetermined quality and patient satisfaction outcomes (Cleveland et al., 2019). It is an encouragement for hospitals, physicians, and other providers to meet performance standards (Delbanco et al., 2018). While the evidence indicates that pay-for-performance may not be able to alter provider behavior dramatically on its own, it may be effective if incorporated with other incentives (Delbanco et al., 2018). One drawback for providers is that under pay-for-performance, bonuses are paid too long after providers deliver patient care, making it difficult for them to connect rewards to their behavior.
The ACA benefits low-income families by lowering health costs through Obamacare. The strategy of Obamacare was to provide tax credits for insurance to the middle class, those whose incomes fall between 100% and 400% of the poverty level. It limits out-of-pocket costs to $8,150 for an individual plan and $16,300 for a family plan in 2020, and $8,550 for an individual plan and $17,100 for a family plan in 2021 (Amadeo 2021). Under the ACA, parents are also allowed to cover their children up to 26 on their plans. This plan has the most effect on providers.