Things are changing quickly, at first it was little things like you are now a primary care provider instead of a GP or Family Physician. Today I read that we are now First Level Providers , or Second Level Providers instead of a specialist. What's in a name....? Everything. Nomenclature often defines the culture, and new vocabulary and abbreviations change the way we think, write and do.
I am now lumped in with "Vision Care Providers"....which seems to lump me in with Opticians, and Optometrists. One thing I was always challenged with is the relative lack of sophistication and/or knowledge as to the difference between and O.D. (Optometrist) and M.D. (Ophthalmologist). In recent years Optometrists become certified in therapeutics for treatment of some eye conditions. The threshold for medical treatment has been lowered substantially.
Health Reform iinvolves both quantity and quality of health care. During the most recent decades there are many who argue that quantity does not equate with quality of care. Measuring quality is challenging at to where to look. Recent ideas include better outcomes (ostensibly measured by the number of reductions in readmission after hospitalization within the first 30 days of discharge. That metric however encompasses a small measure of health delivery.
The outpatient, or ambulatory service setting presents the majority of health expense and visits, save for long term care of the aged population.
The affordable care act will markedly increase outpatient services for states who have opted-in for medicaid expansion. This will be covered in an upcoming edition.
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Showing posts with label outpatient. Show all posts
Showing posts with label outpatient. Show all posts
Tuesday, February 25, 2014
Saturday, February 22, 2014
PPACA AND OUTPATIENT PROCEDURES
HealthCare LeadersMedia expects the Affordable Care Act to cause the number of outpatien proceures to increase for those opted-in for Medicaid expansion in the PPACA. And according to figures there is a spread seen as examined by state. By 2015 California stands to perform 46 million outpatient procedures, while a state such as Texas (opted-out for Medicaid expansion) will decrease by 53 million cases. (reported by Truven Health Analytics)
These figures are further broken down by specialty. Two specialties which create a significant number of ambulatory surgeries, and among the top tier of expense are cardiology and orthopedics. Medicaid opt-in vs opt-out produces some signifcant differences in reimbursement that outweigh numbers of cases. The split per specialty mirrors that of the total number gained or lost in 2016.
Mental health services (Psychiatry) are already in short supply and have previously been throttled by the lack of reimbursement by insurers. PPACA has mandated an increase in these services as a covered benefit. For those states who are opted out the medicaid eligible population will suffer relative to states opted-in. Those who live in states opted-out of Medicaid expansion will not have access to insured care for outpatient psychiatry services.
As expected the variance is greatest for California and Texas which are outliers in the data. In 2016 the volume of Cardiology cases in Califonia will increase by 672,000, while Texas will forgo 840,000 cases. These figures also reflect population differences and the number of medicaid eligible patients in each state.
For orthopedic surgery California (opted-in) will benefit from over 299,000 outpaitent orthopedic cases, while states such as Florida and Texas (opted-out) stand to lose near 300,000 orthopedic cases.
The choice to opt-in vs opting out not only effects who will receive benefits in the eligible population but will have significant effects on the hospital industry. The number of outpatient surgerie outweighs the number of inpatient surgeries. Using the present fee for service reimbursement rates under FFS hospitals have been advantaged by higher reimbursement reflected by higher cost. The loss of coverage for medicaid eligible patients not only places them in jeopardy, it also creates significant differences in the infrastructure necessary to deliver these services.
Outpatient services in states who have opted-in will need a business plan to expand capacity which includes not only physical plant, but skilled workers, such as surgical techs, surgeons, expendables as well as revising operating schedules, reducing turn-a-round times and the like.
DME suppliers will reap these benefits in opt-in states.
The figures represent the number of cases gained vs the loss of gain by opting out. The opt-out numbers are a speculation, and do not represent an actual decrease in cases. The number of procedure in any case will not decrease in states that have opted-out.
Increased demand for services always encourages efficiency and technical breakthroughs, to decrease loses and encourage profitability, much as occured with small incison cataract surgery and the development of small incision surgery in cardiology,general surgery and orthopedic surgery.
While ‘futurists’ attempt to predict the effects of the new law, serendipity and the butterfly effect should be expected.
This article also appears in Health Train Express, February 22, 2014. http://healthtrain.blogpot.com
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