Monday, April 5, 2010

Health Care Reform Title I Reimbursement Structure Reporting

I want to continue to look at the health care reform law, what changes it entails and of course my own editorial comments. We will continue to discuss Title I- Quality Affordable Health Care for All Americans. There are a number of insurance industry market reforms that I talked about yesterday.

I did forget one of them and that is the requirement for dependents to be eligible for coverage until their 26th birthday. Right now most plans require a young adult to be enrolled full time in school to be eligible.

I think that these measures are good ones and truly will allow better access to and maintenance of coverage.

There is an interesting requirement under Title I and that is insurance companies must report to the Department of Health and Human Services reimbursement structures that

" improve health outcomes throught the implementation of such activities as quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives".

"implement strategies to prevent hospital re admission"

" implement activities to improve patient safety and reduce medical error through the appropriate use of best medical practice, evidence based medicine, and health information technology".

"implement wellness and health promotion activities".

Now this is not a requirement to make these things happen. It is a requirement to report reimbursement structures that encourage these activities. The first one and the fourth one I don't have any problem with but I have concerns about the middle two.

Everyone in the health field agrees that hospital readmissions are costly. Hospital readmissions are referring to someone having to be rehospitalized within a short time for the same condition that they were there for the first time. At present no one is denied rehospitalization and reimbursement is provided. We need to lower costs by reducing unnecessary admissions but changing the reimbursement structure is not the best way to go about it in my opinion. If this meant reimbursing for full time in home nursing coverage and ancillary services such as respiratory therapy that would help. But I don't think that is how the insurance companies will go about it. The most likely reimbursement structure change will be providing the hospital a fixed amount of money for certain episodes of conditions whether the person is hospitalized once, twice, or more. This is going to make the hospitals think twice before readmitting patients with chronic illnesses such as end stage renal disease, chronic obstructive pulmonary disease , schizophrenia etc.

I believe this change will occur long before there are adequate community structures in place to allow the types of intensive care needed in the community whether it be at home or nursing facilities. We have already seen how that worked in mental health when the community mental health act was passed, states were no longer fully responsible for treating chronic mental disorders, and the state hospitals were emptied without adequate community funding. If hospitals think twice before readmitting patients and there are not adequate community resources marshalled those with chronic illnesses will die earlier. There will be significant cost savings however.

Tomorrow I will talk about the third requirement to report reimbursement structures to improve patient safety and reduce clinical errors through the use of best clinical practice and evidence based medicine. There are pluses and minuses to that requirement.

Thought for the day
"Set your mind on things above, not things on earth".
St. Paul


No comments:

Post a Comment

Thank You For Your Comment!

CARF - Commission on Accreditation of Rehabilitation FacilitiesNATSAP | National Association of Therapeutic Schools and ProgramsNBCCNAADAC