The Affordable Care Act, otherwise known as Obama Care is a reality for many patients now, even those who haven’t been insured due to finances or pre-existing conditions. How does it affect them, and how does it affect the medical practices that must follow its tenets to provide care?
You’ll want to make sure your practice is in compliance with navigating the changes brought about by the Affordable Care Act. It might be President Obama who began this policy of care, but it’s up to you to really make it affordable - for your practice. So how do you do so? Where do you start?
At MedTrainer we can help you identify the criteria you need to follow to make the ACA work well. Our compliance programs are key to understanding all the new rules and regulations that are a part of medical care today.
Specifically in regard to the ACA, you have certain steps you must undertake and help your patients to follow.
First, you’ll need to help your patients whenever possible to get the help they need. Answer questions, and direct them to the most helpful guidance and information. The American Medical Association will help you help them through the changes.
Note that health care’s changes - the Obama care reforms - are undoubtedly creating many changes for medical practices this year. Providing more comprehensive care, rewarding providers for providing it, and how practices will handle these changes all determines success in today’s medical workplace.
So what changes have come or are coming due to the ACA, at least in part?
One obvious paradigm is a change from private medical practices to medical networks by many physicians. You know who you are! You’re moving into larger practices owned by groups or hospitals, rather than working on your own.
The reason? Cost savings and efficiency - physicians are able to see more patients, as well as providing more options in terms of specialities, and share the costs and learning involved in the administration of the new ACA.
After all, today health care providers must demonstrate their services result in better patient health. If they don’t, under Obamacare, Medicare and Medicaid payments will be rather dramatically reduced.
Along with this shift to the approach of practices from solo to group, the change that’s about to come is a switch from paper to all electronic medical records.
Certainly this is an eco-friendly approach, but that’s the least of the reasons for this shift to occur. The medical profession has to learn and succeed at learning a new way of record keeping. The Health Information Technology for Economic and Clinical Health or HITECH Act, which forms a part of the government's 2009 economic stimulus package, begins the basics of health care reform. Electronic records are a part of that process, and HITECH offers incentive - some $27billion in Medicare and Medicaid incentive payments for early adaptation of electronic record guidelines. These record keeping skills, once learned, will reduce costs greatly over time. The tough part for your practice is actually getting it down cold while handling your medical work load. That’s where outside help and education programs are key to efficient success.
To receive payments for adapting new standards for record keeping, medical practices and hospitals must show the systems used pro-actively to improve patient care. Doctors participating in the program can receive up to $44,000 from Medicare and up to $63,750 in payments from Medicaid. That’s an incentive that continues at slightly lower rates of return in 2015, too.
If you need help utilizing electronic health care records, in the end, accepting that help will be beneficial for your practice. While two thirds of family practice physicians already do utilize electronic record keeping, those who haven’t switched yet are lingering in the past due to the time and money the switch will cost, particularly those whose billing and record keeping systems rely on technology that’s obsolete by today’s ever-changing standards.
Reluctance is one thing, but electric health records in and of themselves can really help a practice, certainly from the dual standpoints of security and privacy for patients. HIPAA’s privacy protection makes this vital. Today, any leaked information becomes Internet fodder which can affect a patient’s career or even their finances. Look at the recent debacle with Target stores nationwide. Translate that into a medical practice, and there are a lot more problems to contend with. In short, for your safety and that of your patients you need to change the way you collect patient payments. And because of the Affordable Care act, you will need to be ready for a lot more patients.
You’ll see that doctors will need to become more aware of the business side of the medical business. From billing to collection, to knowing just what costs an insurance company will and won’t cover. A system that can include electronic billing and online credit card payments will be more efficient for patients and their provider.
There are also some new standards at play with the ACA in regard to payment. In the past, patients who couldn’t pay their bills and patients who refused to pay their bills would be lumped together and turned over to a collections company. Today, doctors can differentiate between those who can and won’t pay.
Billing and fine points of collections aside, overall the ACA will impact doctors in a major way. There will be more patients, because more people will have health insurance. But you will also have to determine what care network has access to your services, to be certain patients can use their ACA plan for your services.
In general, medical practices want to see The Affordable Care Act be a success. While the ACA was discussed 2010, The Commonwealth Fund, a private foundation promoting better health care for all Americans, released a study showing some 60 percent of Americans without health insurance didn’t get medical care even if they needed it, due to the expense involved. Now they will have a greatly reduced expense. And you will have more patients.
And what about Medicare payments, you ask? Are they unsustainable? At one time, the original ObamaCare plan considered cutting Medicare payments due to the idea that Medicare payments were not sustainable. But instead, payments by Medicare are frozen with reforms, and standing pat due to Congressional intervention.
The ACA also includes a measure designed to create incentives that make certain Medicare patients get proper treatment. There are extremely positive signs from these incentives, with care quality increasing and costs for Medicare patients decreasing, which looks positive for the success of cost-control in the Affordable Care Act. Insurers and providers alike seem to be on the same page where quality of care is concerted. Encouraging news - and worth the difficulties of establishing the compliance methods necessary for the ACA.
And Medicaid? Looks like medical practices will receive parity with the payments for Medicare, at least in states expanding a Medicaid program. More patients and higher rates paid to physicians are obviously positive effects.
Less positive is the fact that some new health insurance plans are the recipients of limited physician networks. You have to sign up to accept insurance through the ACA, and incentives to do so, particularly in under-served communities could use improvement. But the incentives currently offered, particularly in under-served areas is a start - a ten percent bonus to open or continue a medical practice in an under-served area.
To sum up, ObamaCare - the ACA - has already added 2.5 million young adults as insured participants in the medical system. Under the age of 26, they’re allowed to stay on their parents health care insurance regardless of where they live. Pre-existing conditions and lifetime caps have been exclused from insurance coverage. Patient oriented reforms are good for the physicians that provide care, too. Physicians must modernize and move forward, stay compliant, and embrace the new standards of care the ACA commands.
That’s the short and sweet of it - with more inclusive health care and more patients to support medical practices the goal of the long haul.