Affordable Care Act (ACA or ObamaCare) (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- What is the Affordable Care Act (ACA or ObamaCare)?
- What are the major changes to medical insurance? How does the ACA affect Medicare?
- What are the benefits of the Affordable Care Act?
- Find a local Doctor in your town
What are the benefits of the Affordable Care Act?
In response to these changes, hospital, health systems, and physicians will need greater emphasis on primary and preventative care, greater attention to standardization of care, and greater patient participation in high-value health-care decisions. This will require significant investment in clinical decisions support systems, realignment of the physician compensation models to create appropriate incentives, and system-wide changes in patient management.
Cost containment is vital and focus must be on where drivers are, namely chronic conditions, implantable devices, and pharmaceuticals. Forward-thinking organizations must look to decisions around cost containment and ultimately closing the value gap. It would appear, though, that closing the value gap is generally concentrating on one side of the equation. Providers overwhelmingly aim for their organizations' reputations to be based on high quality and patient satisfaction. Providers do not seek to be known as the low-cost provider in today's health-care environment.
Ultimately, the ACA's goal is to increase the quality of health-care delivered as well as increase coverage to the uninsured. It is also the intent of the ACA and the other market drivers to sustain the Medicare program financially. As of May 31, 2013, it was estimated by the program's trustees that Medicare will be sustained until 2026, two additional years from previous estimates.
Though the implementation of the ACA is in phases, the most significant reimbursement impacts to providers will begin in Oct. 2013 with changes in the Disproportionate Share Hospital (DSH) program. Providers have begun to react, however, in preparation for the changes on the horizon.
Editorial note by Charles P. Davis, MD, PhD
There are many specific questions that remain about the true cost and true benefits to those who provide and to those who need health care. Some of these questions are inferred by this general article. The answers to these questions should begin to come as each ACA phase quickly matures. If the ACA phase enhances the health care of most individuals without damaging the health-care system, ACA and its phase may be deemed a success. However, if ACA damages the health care of many individuals (for example, provides limited access to physicians, creates long waits for diagnostic tests, medical drugs become scarce commodities, or patients have poor health-care experiences) or damages the health-care system (for example, fewer doctors, a decline in the quality of medical-school applicants, spiraling costs, and hospital and emergency department closures), the ACA or that ACA phase will be considered a failure. That ACA phase will require quick and effective revision if quality health care is to survive and advance in the U.S. Many potential patients, doctors, and health-care professionals are concerned that provisions in the ACA may not be appropriately amenable to revisions if problems develop.
The ACA is 974 pages long and divided into 10 sections. While short summaries are useful to obtain some general understanding of this massive change in health care, for a more complete grasp of this law, it is best to read all of its details. Readers can find the complete ACA at the following site: http://housedocs.house.gov/energycommerce/ppacacon.pdf.
United States. Cong. House. Office of the Legislative Counsel. "Compilation of Patient Protection and Affordable Care Act." 111th Cong., 2nd sess. Washington, DC: GPO, 2010.
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