1 / 28

Affordable Care Act: Negative Implications

Affordable Care Act: Negative Implications. Roger Anderson, Leslie Burgy, Margie Pokorski, and Carolyn Sucaet Siena Heights University LDR-614 August 13, 2013. Introduction to the Affordable Care Act. Key Areas of Concern Quality Satisfaction Cost Access IT Issues

gita
Download Presentation

Affordable Care Act: Negative Implications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Affordable Care Act: Negative Implications Roger Anderson, Leslie Burgy, Margie Pokorski, and Carolyn Sucaet Siena Heights University LDR-614 August 13, 2013

  2. Introduction to the Affordable Care Act • Key Areas of Concern • Quality • Satisfaction • Cost • Access • IT Issues Overall, issues with implementation will outweigh any potential benefit

  3. ACA Quality Issues -Overview One stated intent of the Affordable Care Act is to improve quality. This is to occur using the following methods: • Values-Based Purchasing (VBP) • Health Insurance Exchanges (HIE)

  4. ACA Quality Issues-VBP • 33 Approved measures to determine how well ACOs meet minimum quality standards Issues • This is a very finite or limited list • No high-level evidence that this enhances quality (O’Brien, Kumar & Mertsky, 2013) • Described as a “…program built on penalties…” (Shoemaker, 2011) • Gaps in areas of focus may lead to decreases in quality (e.g. Behavioral Health)

  5. ACA Quality Issues-VBP Diversion • Funding will tend to follow those areas that are being measured • This is parallel to the “carve-out” methodology seen earlier in Medicaid programs • Costs increase when care shifts to another setting • This could be seen when a patient with behavioral health issues such as depression is unable to receive OP services and seeks emergent care during a crisis, possibly leading to an acute admission

  6. ACA Quality Issues-Resources • The ACA’s quality mandates have forced funding to shift in order to support these initiatives • Now that key quality measures are linked to reimbursement, there is more money dedicated to initiatives around re-admissions and LOS • This can draw away from funding of new research and clinical innovation

  7. ACA Quality Issues-Technology • Costs will also be incurred for technology related to Health Information Exchange (HIE) development and the use of data. • No total has been quantified inclusive of capital, operations, and ongoing maintenance • No provision in the act to keep the systems current or up-to-date • Concerns have been noted with the public trust regarding data security. This can result in lack of accurate or complete data and undermine the quality

  8. ACA Cost Issues – Goals/Methods • Goal: Increase coverage for 32 M uninsured • Methods: • Medicaid Expansion • State Insurance Exchanges • Uninsured Purchase Mandate

  9. ACA Cost Issues – Projections/Funding • CBO projects increased Federal Government spending by almost $1Trillion over the subsequent decade. • Six Funding Sources: • 14% Reimbursement reduction to private Medicare Advantage Programs • 33% decrease in MC reimbursements to hospitals • 0.9% increase in MC payroll tax with extension for higher incomes

  10. ACA Cost Issues – Projections/Funding • 11% revenues from new taxes from other health sectors • 3% increase in revenue from Cadillac tax • 21% increase in tax revenue from other areas such as penalty payments and “higher wages resulting from reduced employer spending on health care insurance”

  11. Cost Projections- Administrative • CBO’s estimates do not include $274.6 B to administer programs related to ACA • $7.5 B IRS enforcement • $7.5 B CMS administration • $50 B Grant programs • $209.6 B MC Physician Payment Reform • Additional deficits of $562 B in the first 10 years

  12. ACA Cost Issues - Medicaid Expansion • As of June 2013, 14 states have chosen to opt out of expansion due to cost • Tennessee: 1994 Expansion to cover 500,000 residents increased costs from $2.5 - $8B in 10 years • Alabama: Gov. Bentley refused to participate due to projected cost of $50M annually • Massachusetts: costs continue to grow 8% annually despite recommendations to control spending

  13. ACA Cost Issues - Health Insurance Exchanges • CBO projects 20-23 million covered through exchanges • Average 2014 individual market premium in 11 states for silver-tiered plan $321 compared to $450 current market average • How feasible to predict individuals will begin spending $4000 or 8.4% of their income for insurance versus paying penalty of 2.5% ($1,150) or $695 (whichever greater)

  14. ACA Cost Issues - Employers • Employers opting out and paying penalties may be more economic than mandates • SouthWest Airlines estimated costs to company at additional $414 M annually in order to comply with ACA regulations • Unclear as to extent of corporate savings achieved to offset increased tax revenue projected

  15. ACA Costs- Summary • Implementation Costs: $940 B by 2019 • Additional Administration Costs $562 B in first 10 years • Total $15.02 B in 10 years

  16. ACA Access Issues Supply Driven Demand

  17. ACA Access Issues Underuse

  18. ACA Access Issues Information Technology

  19. ACA Access Issues Patient Satisfaction

  20. ACA Access Issues Physician-Centric Care

  21. CONCLUSION “The changes we would need to mobilize in pursuit of the Triple Aim (care, health and cost) are large, and the obstacles are daunting” ( Berwick, Nolan, & Whittington, 2008,p.76) Biggest Barriers: Supply driven demand New Technologies Physician-centric Care

  22. Conclusion • Cumulative impact of barriers is making any substantial increase in quality unlikely • “Iron triangle” of healthcare reform prevails: “Cost, quality, and access constrain each other in complicated ways” (Clarke, 2013, p. 47) • Leaders should prepare for increased costs • Consumers should prepare for increased expenses or increased taxes, or both

  23. REFERENCES Ancker, J. S., Edwards, A. M., & Miller, M. C. (2012). Consumer perceptions of electronic health information exchange. American Journal of Preventive Medicine, 43 (1), 76-80. Bao, Y. P., Casalino, L. P., & Pincus, H. A. (2012, November 28). Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization. Journal of Behavioral Health Services and Research, 1-11. Becher, E. C., & Chassin, M. R. (2001). Improving the quality of health care: Who will lead. Health Affairs, 20(5), 164-179. Bergner, A., & Thompson, M. (2013). The new economics of health care benefits. FinancialExecutive, 29-32. Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769. Block, J. (2013, July 18). Reform update: Obama touts ACA benefits amid GOP efforts to dismantle provisions. Retrieved from Modern Healthcare: http://www.modernhealthcare.com Brock, J., & Boutwell, A. E. (2012). How did we make transitions such a big deal? Journal of American Society on Aging, 36(4), 35-43. Cantlupe, J. (2013). Primary care finds a (medical) home. HealthLeaders, 43-48.

  24. REFERENCES Clarke, S. P. (2013, March). Healthcare reform in 2013: Enduring and universal challenges. Nursing Management, 45-47. Colchamiro, E., (2012, July-August). Affordable Care Act upheld: Understanding what could come next. Physician Executive Journal, 78-80. Colwill, J. M., James, C., & Kruse, R. L. (2008). Will generalist physician supply meet demands of an increasing and aging population? Health Affairs, 27(3), 232-241. Davis, K., Schoenbaum, S. C., & Audet, A.-M. (2005). A 2020 vision of patient-centered primary care. Health Policy, 953-957. Frerick, E. A., & Lechner, K. E. (2012). Health care reform and young adults' access to sexual health care: An exploration of potential confidentiality implications of the affordable care act. American Journal of Public Health, 102(10), 1818-1821. Frisse, M. E., Johnson, K. B., Nian, H., Davison, C. L., Gadd, C. S., Unertl, K. M., et al. (2012). The financial impact of health information exchange on emergency department care. Journal of the American Medical Informatics Association, 19, 328-333.

  25. REFERENCES Gardner, D. B. (2013). Health insurance exchanges: a call for nursing action. Nursing Economics, 31 (3), 152-154. Gorrin, S. H. (2011, May). The Affordable Care Act: Background and analysis. National Association of Social Workers, 36(2), Grens, K. (2013). The high-deductible trap. Modern Healthcare, 6-7. Green, J. A. (2011, April). The physician hospitals of america's constitutional challenge against the stark law amendments within the patient protection and affordable care act. Health Law Perspectives, 1-9. Retrieved from http://www.law.uh.edu/healthlaw/perspectives/homepage.asp Gruber, J. (2011). The impacts of the affordable care act: How reasonable are the projections? National Tax Journal, 64(3), 893-908. Hacker, K., & Walker, D. K. (2013, May 16th). Achieving population health in accountable care organizations. American Journal of Public Health, e1-e5. Holtz-Eakin, D., & Ramlet, M. J. (2010). Health care reform is likely to widen federal budget deficits, not reduce them. Health Affairs, 29(6), 1136-1141.

  26. REFERENCES Jacobi, J. V., Watson, S. D., & Restuccia, R. (2011, Spring). Implementing health reform at the state level: Access and care for vulnerable populations. Using Law, Policy, and Research to Improve the Public's Health, 69-72. Kaiser Commission on Medicaid and the Uninsured. (2012, February). The Henry J. Kaiser Family Foundation. Retrieved June 18, 2013, from www.KFF.org/KCMU: http:// kaiserfamilyfoundation.files.wordpress.com/2013/01/8046-02.pdf Lau, R., & O'Connor, M. (2012). Behind the rhetoric: is palliative care equitably available for all? Contemporary Nurse, 43 (1), 56-63. Lee, T. H. (2010, April). Turning doctors into leaders. Harvard Business Review, 50-58. McBride, T. D., Barker, A. R., Pollack, L. M., Kemper, L. M., & Mueller, K. J. (2012). Federal employees health program experiences lack of competition in some areas, raising cost concerns for exchange plans. Health Affairs, 31(6), 1321-1328. Merisalo, L. J. (2013, January). The top ten in 2013. Healthcare Registration, 22(4), 9-11.

  27. REFERENCES Murray, T., Schappe, A., Kreienkamp, D., Loyd, V., & Buck, E. (2010). A community-wide academic-service partnership to expand faculty and student capacity. Journal of Nursing Education, 49(5), 295-299. O'Brien, J. J., Kumar, A., & Metersky, M. (2013). Does value-based purchasing enhance quality of care and patient outcomes in the ICU? Critical Care Clinics, 29 (1), 91-112. O'Connor, S. J. (2012). Editorial. Healthcare Management, 57(6), 375. Price, C. C., & Eibner, C. (2013). For states that opt out of medicaid expansion; 3.6 million fewer insured and $8.4 billion less in federal payments. Health Affairs, 32(6), 1030-1036. Rawls, P. (2013, July 14). Alabama covered entirely by insurance exchange. Retrieved from Modern Healthcare: http:// www.modernhealthcare.com Shoemaker, P. (2011). What values-based purchasing means to your hospital. Healthcare Financial Management, 61-68. Showalter, J. S. (2013, January). SCOTUS and the voters have spoken, where do we go from here? Healthcare Financial Management, 66-71.

  28. REFERENCES The Daily Briefing. (2012, May 1). Retrieved from The Advisory Board: http://www.advisory.com/Daily-Briefing/2012/05/01/Et-cetera Turner, G. M. (2013). A model for reform. Modern Healthcare, 43(18), 28-29. U.S. Government Accountability Office. (2011). Pre-existing condition insurance plans. Medical Benefits. Verret, D. & Rohloff, R.M. (2013). The value of palliative care. Healthcare Financial Management, 50-54. Wood, D. (2013, July 3). How the 'fiscal cliff' deal, ACA and other changes will affect nurses this year. Retrieved from http:// www.nursezone.com (2012, July 6). The iron triangle of health care – implications for the ppaca. Image retrieved from http://ficklefinger.net/blog/2012/07/06/ the-iron-triangle-of-health-care-implications

More Related