The First Constructive- Healthcare Reform Outline

Dori Beaumont

Comm 1270

The First Constructive (Prima Facie)

Health Care Reform

Introduction – Health care reform is necessary.  Healthcare costs continue to rise.  According to Forbes magazine, in 2012 healthcare cost rose almost twice as fast as the average consumer good.  Some of the new programs included in the Affordable Care Act are lacking in reaching the goals and objectives set by the Obama administration.

Thesis Proposition - The United States is in critical need of health care reform. Offering healthcare coverage to everyone is both necessary and “the right thing to do.”  But, some of the current programs imbedded in the Affordable Care Act are fraught with missteps. Specifically, the current Bundled Payment program needs to be reconsidered.

Define key terms:  bundled payment  A single comprehensive payment made to healthcare providers—hospitals and physicians—for a group of related services, based on the expected costs for a clinically defined episode of care.

Issue A: The bundled payment plan proposed by Obamacare is laden with missteps from unprepared administration of the program to potentially compromising the care of the patient.

Claim 1: The bundled payment program is unsuccessful.

Warrant 1:  The bundled payment plan is one reimbursement/payment to one entity for all services related to that condition for a specific period of time. The payment is generally made to a hospital system and then dispersed to the individual entities including:  physicians, therapists, pharmacies, skilled nursing facilities etc. Currently, there are 48 qualifying episodes for the CMS trial.  This could be anything from pacemaker implementation, stroke, joint replacement, to artery bypass graft surgery. Patients with certain co-morbidities (diseases) who are at a greater risk of readmission after a surgical procedure will find it hard to get care.  The options become:  refusal of care, decreased reimbursement for the hospital system distributing the payment, or considering using lower cost, possibly inferior equipment, medications or facilities.

Claim 2: Bundled payment program could use substandard products or technology.

Warrant 2: The bundled payment program opens the possibility of using inferior products or services.  With cost of care being so paramount to the success of the organization, consideration of using inferior or less effective product is a possibility. The long term effects are less successful outcomes, decreased patient satisfaction or quality of live or even death.

Immediate harms include patient dissatisfaction with the care provided. Patient’s expectations for care could not be met.  The possibility of limiting access to care may be a real issue. 

For example, the CDC  states that the costs of patients with chronic illness account for 75% of US healthcare costs.   Since 2000, health insurance premiums for a typical family of four have increased by 114%.  We cannot sustain these costs and we cannot spend valuable dollars on ineffective programs. The long term harm could be waiting too long for a procedure and jeopardizing health, health care systems being financial unstable and without funding we will see a decrease in progressive technological advancements.

Underview or Conclusion:  There has to be continued health care reform.  Currently costs are predicted to rise over 6.8% in 2015 once again out pacing inflation according to Pricecooper waterhouse’s recent survey. The bundled payment program has been unsuccessful.  As with the Obama care insurance registration, the program was not prepared for roll out. IT programs were not properly set up  to receive this type of claims, the different entities weren’t educated properly to understand how to bill or where to get their portion of the reimbursement.  CMS wasn’t prepared for the appropriate negotiations with the health care systems.  Reimbursement for outcomes can cause patient care to be diminished i.e. lack of appropriate re-admission or appropriate treatment options. There is also the risk of using inferior supplies. The Centers for Medicare and Medicaid have been piloting this program for almost two years and they are still finding it very difficult to get participation from various health care systems.  Currently, there are only 18 sites that are participating in the model 4 portion. Community hospitals are closing at an increased rate leaving patients without health care. We are at a critical state in the health care realm.  The Bundled Payment program of the Affordable Care Act is ineffective, too many resources have been spent trying to keep the program going with too little preparation for implementation.