5 wk HCS440 Legislations Influence in Health Care & what Changes final

Editor's Notes

• #2: Legislations Influence in Health Care & what Changes can be made for the Better? By: Maile Andrus HCS/440 July 27, 2015 Michele Burka Good Morning and Welcome! We are going to be taking about the influence that legislation has on health care can be seen throughout the history of modern health care. Over the last approximately 25 years there have be some ground breaking changes, there are three that legislation has help to introduce in hopes to help reduce health care out of pocket costs. While two have been around and have been wildly accepted there is one that continues to be controversial. We will also be looking at ways to try and fix the broken system, may take the time that needs to be monitored to keep the costs down to the public. The legislation has on health care cost there needs to be changes so that the American population will still be able to afford health care in the future.
• #3: Influence of Legislation on Health Care A Brief Introduction First was the Welfare Reform Act of 1996 is also known by the name “The personal Responsibility and Work Opportunity Reconciliation Act or PRWORA, P.L.104-193” (Valerius, 2014, p.361), which was designed to replace another program called Aid for Families with dependent children or (AFDC) and to help with those individuals that are receiving Social Security Incomes that needed additional assistance or those Medicaid eligible. (Burke, 1996-2003). Also created in 1996 was the Health Insurance Portability and Accountability Act (HIPAA) which is simply are “Federal laws or act that set forth guidelines for standardizing the electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy” of health information for each patient (Valerius, 2014, pp. GL-7). These are strict rules that cover patient’s private and sensitive information ensuring confidential by helping to reduce the loose or the breach. While the last and most controversial legislative influence in the United States as the nation continuing to struggles through some of the worst economic times in the past forty to 50 years is the new Healthcare Reform Actor (ACA) put into action as of January 2014 (Cafasso, 2011). For years the US Government under President Obama, has debated over the Affordable Care ACT (Austin, A and Wetle, 2012), better known throughout the country and the world as Obamacare. The implementation of the ACA was believed in theory to provide everyone in the United States (US) would be covered by health insurance and would relieve some of the federally funded Healthcare ran programs already in place. (Healthcare Timeline, 2014) However, since the onset of the act the overall opinion from not only the American public but from those in Government that we the ACA is not that Affordable. Because of the controversy of the ACA this is the most critical and current legislated act that needs further investigating to determine weather it will end up having the desired affect that it was designed to have. References: Austin. A and Wetle, V. (2012). The U.S. Health System. In The U.S. Health Care System (2nd ed.). Healthcare Timeline. (2014). Retrieved from University of Phoenix: http://www.pbs.org/healthcarecrisis/history.htm Burke, V. (1996-2003). The 1996 Welfare Reform Law. Retrieved from CRS, Welfare Reform Briefing Book: http://royce.house.gov/uploadedfiles/the%201996%20welfare%20reform%20law.pdf Cafasso, E. (2011, March 21). How health-reform stakeholders will be affected by recent changes. Retrieved from The Public Relations Strategist: http://www.prsa.org/Intelligence/TheStrategist/Articles/view/9071/1028/How_health_reform_stakeholders_will_be_affected_by#.VBdIXvldWSo
• #4: Common tools to Identify & Address the Economic Challenges Common Tools Centers for Disease Control and Prevention (CDC); Public Health Economics and Tools This tool is very use full for many reasons and can help estimate such things as cost analysis that to determain the what the financial cost innovated treatments interventions and programs of various illnesses. It also allows for the cost analysis of certain disease's like Cancer and the possibilities of out-breaks of contagious diseases. The CDC also, takes the nations economics status very seriously and uses it can help determain the “systematically identify, measure, value, and compare the costs and consequences of alternative prevention strategies”(Mark L. Messonnier, 2006). Analysis of Economic Prevention Benefits Which is created to help health care managers and communities to evaluate as well as understand the costs of health care prevention. (Wilhelmine Miller, 2013) Economic Changes Centers for Disease Control and Prevention (CDC); Public Health Economics and Tools This site also takes a look at the economic impact of cost effectiveness of the community public health care prevention. (Amanda Honeycutt, 2006) This process was created and will collate the information in to a cohesive document to release the findings to the public and to help keep a accurate record of information There are more families that are considered low-income. Do to the high rate of unemployed members of families and the rising cost of general needs to support the household in the United State. According to U.S. National Library of Medicine, in 2000 64% of the population was insured through their places of employment. “An additional 24% of our population in the same year was covered by some type of government plan. The breakdown is as follows: Medicare, 13%; Medicaid, 10%, Military Health Insurance, 3%” ( Napper & Newland, 2014). While if we look at the 1960 the cost of health care in the United States was around $27 billon, and since then it was estimated to be about $1.7 trillion “In 2003, public funding sources. As out-of-pocket spending accounted for 16 percent is the next largest private source. Medicare and the federal share of Medicaid comprise the bulk of the federal government’s support. The States’ share of Medicaid is the largest component furnished by State and local governments,” (ASPE 2005).   Aging Today’s society is generally made up of aging group of individuals known as the Baby Boomer Generation. While the national makeup has been changing over the past approximately one hundred years with changes in the American population from young families with 6 or more children to families that have become more diverse and smaller. The nation as a whole has begun to see an increase in age and aging adults do to the advancements in medical treatments and a trend in healthier living as the nation ages; projections are that by 2050 there will be a consistent decrease in births, deaths and immigrations trends. (Cohn, 2001). Combined that information with the increase in age; by the Baby Boomer population. According to “The Graying of America”, (The Graying of America, 2005) from the Boston Globe, page A18, Baby Boomers are living longer in their own homes or being cared for in nursing homes when their families have moved away, and they can no longer help take care of them. If we look further into the article U.S. Population Projections: 2005-2050, (Cohn, 2001) we see that the population of the United States is changing dramatically, from 2005 when the article was written there was roughly “1 in every 8 individuals was currently immigrated to the United States which is roughly 12% of the population of the United States and that number has continued to grow the estimated population of immigrants or foreign born will surpass native born individuals by the year 2025” (Cohn, 2001, p.1). The belief is that this will prove to be a gradual increase by 2050 the number of immigrants to nationally born Americans will be “1 in 5 or roughly 19% of the United Stated population and 29% of the total amount is estimated to be Hispanic in nature” (Cohn, 2001, p.1). References: Amanda Honeycutt, L. C. (2006, 3). Guide to Analyzing the Cost-Effectiveness of Community Public Health Prevention Approaches. Austin. A and Wetle, V. (2012). The U.S. Health System. In The U.S. Health Care System (2nd ed.). Healthcare Timeline. (2014). Retrieved from University of Phoenix: http://www.pbs.org/healthcarecrisis/history.htm Mark L. Messonnier, P. (2006, 12 22). Economics and Public Health at CDC. (SUP02), pp. 17-19. Valerius, B. N. (2014). Medical Insurance An Integrated Claims Process Approach (6th ed.). McGraw-Hill Higher Education. Wilhelmine Miller, D. R.-E. (2013). A Review and Analysis of Economic Models of Prevention Benefits. ASPE Report. Long Term Growth of Medical Expenditures- Public and Private, ASPE Issue Brief; U.S. Department of Health and Human Services, March 2005 Retrieved from http://aspe.hhs.gov/health/medicalexpenditures/ Overview Of Health Care Financing: A Self Study Course U.S. National Library of Medicine August 2014 Retrieved from http://www.nlm.nih.gov/nichsr/edu/healthecon/02_he_01.html
• #5: Discuss how the methods and tools identified relate to health care reform. Welfare Reform Act Very little that needs to be changed with Welfare Reform Act, known by the name "The personal Responsibility and Work Opportunity Reconciliation Act or PRWORA, P.L.104-193" (Valerius, 2014, p.361). However, there need to be stricter laws and tougher restrictions for those Americans that seek to receive assistance. In speaking with some individuals and their concerns as to some finances that the program distributes to the public, there is a belief that there is a draining the funds that are currently available. Health Insurance Portability and Accountability Act (HIPAA) Health Insurance Portability and Accountability Act (HIPAA); there is little need to change except stiffer penalties for breaches; as this legislative influence. HIPAA, created to protect the patients' rights, confidentiality of medical history it is important for everyone to uphold and maintain the rules of confidentiality. All those individuals that process and handle the processing the patients' medical claims forms (Mercuri, 2004) Is there any fixing Affordable Care Act (ACA)? However, in looking at the Affordable Care Act (ACA) or as we all know it Obama Care, (Cafasso, 2011) there is much that needs to change to reduce the heath care spending. While not an effective system the cost that has be poured into the ACA to try and make it work has added to the cost of health care rising even further. References: Valerius, B. N. (2014). Medical Insurance An Integrated Claims Process Approach (6th ed.). McGraw-Hill Higher Education. Burke, V. (1996-2003). The 1996 Welfare Reform Law. Retrieved from CRS, Welfare Reform Briefing Book: http://royce.house.gov/uploadedfiles/the%201996%20welfare%20reform%20law.pdf Cafasso, E. (2011, March 21). How health-reform stakeholders will be affected by recent changes. Retrieved from The Public Relations Strategist: http://www.prsa.org/Intelligence/TheStrategist/Articles/view/9071/1028/How_health_reform_stakeholders_will_be_affected_by#.VBdIXvldWSo Mercuri, R. (2004). The HIPAA-potamus in Health Care Data Security. Secuirty Watch, 47(7), 25-28.
• #6: Effective method(s) or tool(s) that could be used to resolve current economics affected by the influence of legislation. Welfare Reform Act To correct the issue, mandatory drug testing for those individuals that apply such Government funded programs. This way the Government will be able to save money for those individuals that truly need assistance and determine what number of the American population is living unhealthy lifestyle while on government funded health care. While also being able to track the length of time that an individual is receiving the assistance, as this should only be used as a short term solution. Health Insurance Portability and Accountability Act (HIPAA) Staff member or members that break HIPAA laws creating a violation are fined and receive penalties are imposed. These can be quite costly to the facility or the individuals responsible or both fines can be as much as two hundred and fifty thousand dollars ($250,000.00) (Mercuri, 2004) and depending on the severity of the breach jail time can be assessed as well up to and including a ten (10) year jail term for each violation (Tomes, 2007). As technology continues to changes and health care cost continue to rise, there need to have stricter fines and penalties for those that do not follow these already strict standards that have been set forth. Ongoing testing can aid in reducing breaches and therefore keeping the amount of cost down for health care. Many hospitals or clinics that have breaches need to retrain and restructure security measures so that the breach will not happen in the future along with paying the very costly finds that are associated with each infection. Every health care staff member; should be required to take by annual refresher test and classes covering the HIPAA regulations and laws; this should be factored into the facility annual staffing budget and should not be an underlying cost in health care. (Mercuri, 2004) Is there any fixing Affordable Care Act (ACA)? The first step to fixing the problem is trying to fix the qualification process itself. In fixing the technology side, it will help to reduce the amount of (IT) information technology staff on hand as well as to help maintain the systems security at a more acceptable cost. (Mercuri, 2004) The second would be to have insurance companies find a more cost-effective coverage that not only benefits the facilities and doctors but will be beneficial to the individuals that are seeking to use the ACA for their health care. Affordable should mean that you can afford it, in today's economic crisis any insurance that costs more than $200.00 a month for cover is not affordable. (Greenberg, 2013) The United States Government and the health care conglomerates need to work together for the betterment of the People. That they are trying to help by not only covering them at a reasonable and affordable amount, but that will provide top of the line care. While these changes may seem small, it should being to aid in the reducing of costs and health care spending for the future. Knowing that there is more that need to be done is just the start. For unneeded staff in the automation systems that insurers use to apply for coverage and that will intern reduce the cost of the coverage as a whole for each American that applies for coverage under the ACA. (Balcombe, 2010) References: Mercuri, R. (2004). The HIPAA-potamus in Health Care Data Security. Secuirty Watch, 47(7), 25-28. Balcombe, J. (2010, 8). Impact of Healthcare Legislation on Health Insurance Companies. Retrieved from http://www.irmi.com: http://www.irmi.com/expert/articles/2010/balcombe08-insurance-agency-company-valuation.aspx Greenberg, J. (2013, August 8). Is the health care law hurting the economy? Retrieved from http://www.politifact.com: http://www.politifact.com/truth-o-meter/article/2013/aug/08/ted-cruz-health-care-law-and-legislation-hurts-eco/ Tomes, J. P. (2007). Management of HIPAA Compliance Takes onIncreased Importance with Criminal Enforcement. Journal of Health Care Compliance.
• #7: Identify various payment sources and mechanism used in the health care industry. State and Federally funded Health care plans which are meant to protect and aide those that are aging or disabled, and others such as ; Medicare, part of the Social Security Act (Medicare) (Healthcare Timeline, 2014) was formally known as Health Care Financing Administration or (HCFA) (Austin. A and Wetle, 2012). Medicare is a fully funded health care program funded by the Federal government that everyone pays into during their working years, paid through the employer though the process of payroll deductions and paid directly to the Internal revenue service. The funds that are paid in are paid under the Social Security number that each United States legal individual has. Created for those to be covered in their retirement, or should they become disabled. Medigap, insurance is only available for those individuals that already are on Medicare Part A services. This insurance is also called offset insurance that fills the gap and can pay for costs that Medicare insurance does not cover (Valerius, 2014). Medicaid, was intuited by the Social Security Act called Title XIX or (T19) and varies from state to state based on the number of people and their income compared to the national average income (Valerius, 2014). Private Insurances Health maintenance organization (HMO) – This HMO plan is one of three highly used employer provider health care coverage options and normally requires the employee to pay part of the insurance premium costs and then co-payments or co-insurance premiums as well as deductibles. This plan like PPO and the POS insurance plan options normally run on an annual cycle from January 1st to December 31 of any given year, and any medical deductibles will need to be re-met with the new physical insurance year. (Austin. A and Wetle, 2012) As with the PPO plan the HMO plan is restrictive and there is a coop between the insurance companies and the insured, when choosing to participate, insured individuals knows that they will be responsible for basic fees such as co-payments, and deductibles. (Austin. A and Wetle, 2012) “Most with health insurance is provided through the employer, the employer pays the insurance company a set amount agreed upon in advance”. Austin and Wetle (2012). Then, the insurance companies pay the provider directly for services rendered. The HMO doctors know managed health care plans prearranged dollar amount for all of the services that the doctor provides. (Austin & Wetle, 2012). “In addition, if providers use less in services than the capitated fee, they are paid each month to cover the cost of care, they keep the difference”. (Austin & Wetle, 2012). HMOs also restrict the covered services, which limits autonomy in medical decision-making. Preferred provider organizations (PPO) – This plan is one of three highly used employer provider health care coverage options and normally requires the employee to pay part of the insurance premium costs and then co-payments or co-insurance premiums as well as deductibles. This plan like HMO and the POS insurance plan options normally run on an annual cycle from January 1st to December 31 of any given year, and any medical deductibles will need to be re-met with the new physical insurance year. (Austin. A and Wetle, 2012) As with the HMO plan the PPO plan is restrictive and there is a coop between the insurance companies and the insured, when choosing to participate, insured individuals knows that they will be responsible for basic fees such as co-payments, and deductibles. (Austin. A and Wetle, 2012) “Most with health insurance is provided through the employer, the employer pays the insurance company a set amount agreed upon in advance.” Austin and Wetle (2012). Then, the insurance companies pay the provider directly for services rendered The PPO doctors know managed health care plans prearranged dollar amount for all of the services that the doctor provides. (Austin & Wetle, 2012). “In addition, if providers use less in services than the capitated fee, they are paid each month to cover the cost of care, they keep the difference”. (Austin & Wetle, 2012). PPO’s also restrict the covered services, which limits autonomy in medical decision-making. (Austin. A and Wetle, 2012) Health savings account – HAS This means that while the money may be considered tax fee money, if you do not use the money that is put in the account, you will lose any of the money that is in the account as the new year begins. I also did not know that the account could be activated with a yearly family deductible of $2200.00. I have a personal family Deductible of $3300.00 a year that needs to be met of $1100.00 per family member. (Austin. A and Wetle, 2012) HSA is a medical expense and how the plan works, from being a payroll deduction trough your employer and you are responsible for putting all the money into the account, and you are also responsible for pending it for qualified medical expenses only. (Health Savings Accounts (HSAs)) The benefits to providers for patients that have HSA plans is that should the patient get sick or ill or has an unexpected medical expense they will be able to pay for the service at the time of service reducing the amount of revenue loss that can accured when treating others that may not have a HSA plan. Point-of-service - POS is one of three highly used employer provider health care coverage options and normally requires the employee to pay part of the insurance premium costs and then co-payments or co-insurance premiums as well as deductibles. This plan like HMO and the PPO insurance plan options normally run on an annual cycle from January 1st to December 31 of any given year, and any medical deductibles will need to be re-met with the new physical insurance year. (Austin. A and Wetle, 2012) However here we see a less restrictive coverage type that the point of service is like the Indemnity insurance coverage as the insured can seek out any doctor or facility, but the deductibles are higher than the HMO and PPO plans. Unlike the HMO’s and PPO plans the POS plan is restrictive and there is a coop between the insurance companies and the insured, when choosing to participate, insured individuals knows that they will be responsible for Higher fees such as co-payments, co-insurance and deductibles so that they are not restricted to having to see one doctor over another. (Austin. A and Wetle, 2012) “Most with health insurance is provided through the employer, the employer pays the insurance company a set amount agreed upon in advance”. Austin and Wetle (2012). Then, the insurance companies pay the provider directly for services rendered The insured is responsible to pay all cost to the doctor directly and then they are reimbursed by the insurance provider normally at a preset predetermined price. (Austin. A and Wetle, 2012) Most doctors know that the point of service is based on managed health care plans and treads and have a preset, prearranged dollar amount for all of the services that the doctor provides and they know that the insured or patient has a higher deductible and that the copay needs to be paid as well as the deductible, this plan is geared to the doctor and the doctor know what he or she will be able to charge the customer and what the insurance ill pay before the patient comes in and seeks treatment. (Austin. A and Wetle, 2012) References: Austin. A and Wetle, V. (2012). The U.S. Health System. In The U.S. Health Care System (2nd ed.).
• #8: Which payment source(s) or mechanism(s) are the most effective to resolve the economic The rising costs of Health care? There is no insurance that is better than another these days as many insurances companies have raised rate consistently. The question is unanswerable, as ACA is still so uncertain and State and Federal Funding in health care continues to decline. ACA is doing more to hurt the health care system then help and it has not proven it’s self yet to be positive and cost affective for the general population. While this is true, there are a few insurance that are employer/ employee contributor to the health care insurance premiums. There are additional health care plans like flex spending Help those that have some money to set aside funds for medication, and none paid for medical services, that are not covered under insurance like over the counter medicine. As well as health care Savings accounts Again can be helpful if the individual has the ability to set money aside for medical expenses, whether they need it or not.
• #9: To combat the rising costs of health care and help redefine the ACA so that it is truly Affordable. Reduce the amount of people that are on State and Federally funded health care, for such things as drug abuse, alcohol abuse, and welfare. Put a freeze on health care costs until such time there can be sufficient changes made to the health care cost percentages annual increase. Make those that are State and Federal funded health care just like welfare have to supply proof that they are looking for work, and that they would be required to take a random drug tests and screenings.
• #10: Conclusion While this is just the start to a long continuing fight Cruz like the rest of the Nation will have to see what the final numbers hold and if the new legislation will in fact help or hurt the Countries economic health as well as that of the population. Truly only time will tell if the ACA will remain a constant fixture in the legislation or if the next Government leaders will repeal and start over. The bottom line is that there needs to be greater accountability from doctors and the insurance companies to help reduce the costs and spending in health care. Accountability starts with making sure there is the right staff for the job. That they are well trained so that there is the less wasted time that will reduce the number of funds it will take to correcting a problem. (Valerius, 2014) Reference Valerius, B. N. (2014). Medical Insurance An Integrated Claims Process Approach (6th ed.). McGraw-Hill Higher Education.
• #11: References Burke, V. (1996-2003). The 1996 Welfare Reform Law. Retrieved from CRS, Welfare Reform Briefing Book: http://royce.house.gov/uploadedfiles/the%201996%20welfare%20reform%20law.pdf Cafasso, E. (2011, March 21). How health-reform stakeholders will be affected by recent changes. Retrieved from The Public Relations Strategist: http://www.prsa.org/Intelligence/TheStrategist/Articles/view/9071/1028/How_health_reform_stakeholders_will_be_affected_by#.VBdIXvldWSo Amanda Honeycutt, L. C. (2006, 3). Guide to Analyzing the Cost-Effectiveness of Community Public Health Prevention Approaches. Austin. A and Wetle, V. (2012). The U.S. Health System. In The U.S. Health Care System (2nd ed.). Healthcare Timeline. (2014). Retrieved from University of Phoenix: http://www.pbs.org/healthcarecrisis/history.htm Mark L. Messonnier, P. (2006, 12 22). Economics and Public Health at CDC. (SUP02), pp. 17-19. Valerius, B. N. (2014). Medical Insurance An Integrated Claims Process Approach (6th ed.). McGraw-Hill Higher Education. Wilhelmine Miller, D. R.-E. (2013). A Review and Analysis of Economic Models of Prevention Benefits. ASPE Report. Long Term Growth of Medical Expenditures- Public and Private, ASPE Issue Brief; U.S. Department of Health and Human Services, March 2005 Retrieved from http://aspe.hhs.gov/health/medicalexpenditures/ Overview Of Health Care Financing: A Self Study Course U.S. National Library of Medicine August 2014 Retrieved from http://www.nlm.nih.gov/nichsr/edu/healthecon/02_he_01.html
• #12: References Continued Mercuri, R. (2004). The HIPAA-potamus in Health Care Data Security. Security Watch, 47(7), 25-28. Balcombe, J. (2010, 8). Impact of Healthcare Legislation on Health Insurance Companies. Retrieved from http://www.irmi.com: http://www.irmi.com/expert/articles/2010/balcombe08-insurance-agency-company-valuation.aspx Greenberg, J. (2013, August 8). Is the health care law hurting the economy? Retrieved from http://www.politifact.com: http://www.politifact.com/truth-o-meter/article/2013/aug/08/ted-cruz-health-care-law-and-legislation-hurts-eco/ Tomes, J. P. (2007). Management of HIPAA Compliance Takes on Increased Importance with Criminal Enforcement. Journal of Health Care Compliance.