Patient protection & affordable care act


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Health reform and its impact on non-profit healthcare organization, as well as its direct impact on Yale-New Haven

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  • Net revenue(net profits) in 2010 for ynhh was 1.4 billion
  • Patient protection & affordable care act

    1. 1. Impact on Hospitals
    2. 2. <ul><li>Signed into law March 23, 2010. </li></ul><ul><li>Specific Provisions to be phased in through Jan 1, 2018 </li></ul><ul><li>Will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. </li></ul>
    3. 3. <ul><li>Reform of private health insurance industry and public health insurance programs. </li></ul><ul><li>Improve coverage for those with pre-existing conditions. </li></ul><ul><li>Expand access to care for 32 million Americans </li></ul><ul><li>Reduce long term costs of the health care system. </li></ul>
    4. 4. <ul><li>Quality, affordable Care for all Americans </li></ul><ul><li>Hospital Value-Based Purchasing Program </li></ul><ul><li>Incentive for Hospitals to implement EMRs </li></ul>
    5. 5. <ul><li>50.7 Million Americans were without healthcare as of September 2010 (US Census Bureau) </li></ul><ul><li>An additional 25 Million are underinsured </li></ul><ul><li>42% of adults 19-64 are underinsured or have no healthcare </li></ul><ul><li>Beginning in 2014, individuals will be required to maintain minimum essential coverage or pay penalties. Employers must also offer health care to employees to avoid penalties </li></ul>
    6. 6. <ul><li>Hospitals are endangered </li></ul><ul><ul><li>Most endangered are rural hospitals, and urban ones in areas with excess hospital beds and a lot of poor, uninsured patients. </li></ul></ul><ul><li>Federal law requires hospitals to provide care for anyone, whether insured or not. </li></ul><ul><ul><li>It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. </li></ul></ul>
    7. 7. <ul><li>“ About 80 percent of the healthcare dollars we spend are used on about 20 percent of the population” –Marna Borgstrom </li></ul>YNHH Uncompensated and Under Compensated Care Costs - 2010 Free care allowance $16,294,000 Charity care allowance $15,514,000 Medicaid underpayments $113,250,000 Bad debts $22,418,000 Total uncompensated and under-compensated care costs $167,476,000
    8. 8. <ul><li>More insured people means fewer unpaid hospital bills </li></ul><ul><ul><ul><li>This means less bad debts and uncompensated costs for hospitals. </li></ul></ul></ul><ul><li>With more people covered, ER ’s could see less OR more crowding </li></ul><ul><ul><ul><li>The once uninsured will now have a choice for health care and may choose to see a family physician for minor illnesses and injuries. </li></ul></ul></ul><ul><ul><ul><li>However, Medicaid beneficiaries make up the majority of ER visits. </li></ul></ul></ul><ul><ul><ul><li>The new health insurance law will increase Medicaid ranks by about 16 million. Many family doctors limit the number of Medicaid patients they take due to low government reimbursements. </li></ul></ul></ul><ul><ul><ul><li>This could mean ER ’s across the nation could see far more crowding. </li></ul></ul></ul>
    9. 9. <ul><li>Workforce expansion </li></ul><ul><ul><li>Yale New Haven Hospital may need additional resources to care for the increase demand for care. </li></ul></ul><ul><li>North Haven Emergency Center may prove to be crucial. </li></ul><ul><li>Provides access to neighboring towns </li></ul>
    10. 10. <ul><li>Hospital payments account for the largest share of Medicare spending, Medicare is the largest single payer for hospital services. </li></ul><ul><li>Every year, as many as 98,000 Americans die from errors in hospital care.  </li></ul><ul><li>1/3 of Medicare beneficiary discharges will be back in the hospital within a month </li></ul><ul><li>These medical errors not only contribute to the suffering of patients/families, but lead to increased spending </li></ul>
    11. 11. <ul><li>In FY 2013, Hospital Value-Based Purchasing Program will distribute an estimated $850 M to hospitals based on overall performance </li></ul><ul><li>Funds to be taken from what Medicare would have spent on hospital stays </li></ul><ul><li>No longer payments based on volume of patients, but based on performance of care. </li></ul><ul><li>This will encourage quality care improvement, meaning better medical practice and fewer complications and readmissions, which in turn will lower hospital expenses. </li></ul>
    12. 12. <ul><li>The Program measures on how closely hospitals follow best clinical practices and how well hospitals enhance patients ’ experiences of care. </li></ul><ul><li>Examples of the care processes included in the measures: </li></ul><ul><ul><li>Percent of Heart Attack Patients Given Fibrinolytic Medication Within 30 Minutes Of Arrival </li></ul></ul><ul><ul><li>Surgery patients who were given the right kind of antibiotic to help prevent infection </li></ul></ul><ul><ul><li>Patient Experience of Care </li></ul></ul>
    13. 13. Yale-New Haven CT Average US Average Patients reported they &quot;Always&quot; received help as soon as wanted. 55% 60% 64% Patients reported their room/bathroom were &quot;Always&quot; clean. 61% 70% 71% Patients reported that area around their room was &quot;Always&quot; quiet at night. 47% 49% 58% Outpatients having surgery who got right kind of antibiotic 65% 92% 94% Surgery patients whose urinary catheters were removed on first or second day after surgery. 82% 91% 90% Heart Failure Patients Given Discharge Instructions 90% 86% 88% Pneumonia Patients Assessed and Given Pneumococcal Vaccination 74% 93% 93% Pneumonia Patients Given Most Appropriate Initial Antibiotic(s) 75% 93% 92% Heart Attack Patients Given PCI Within 90 Minutes Of Arrival 76% 87% 90%
    14. 14. <ul><li>HITECH act – authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHRs to improve care delivery </li></ul><ul><li>“ meaningful use” objectives exist </li></ul><ul><ul><li>Original proposal – mandatory broad set of objectives to be met (23 for hospitals, 25 for clinicians) </li></ul></ul><ul><ul><li>“ too demanding and inflexible” – final regulation – two groups </li></ul></ul>
    15. 15. <ul><ul><li>Enhanced patient care and safety </li></ul></ul><ul><ul><li>Lower healthcare costs </li></ul></ul><ul><ul><li>Improved communication among caregivers and patients </li></ul></ul><ul><ul><li>Ability to track medical care from home </li></ul></ul><ul><ul><li>Provides for more efficient hospitals </li></ul></ul><ul><ul><li>Reduce medical errors </li></ul></ul>
    16. 16. <ul><li>YNHS has begun a multi-year process to implement EPIC, a state of the art EHR system </li></ul><ul><li>EPIC will be implemented by 2013 </li></ul><ul><li>Five-year estimate for building & maintaining EPIC at $250 million </li></ul><ul><li>Every patient ’s medical record will be available online to each of their healthcare providers </li></ul>
    17. 17. <ul><li>It ’s a better way to serve America’s patients </li></ul><ul><li>Improve the overall health of the nation </li></ul><ul><li>It ’s a step in the right direction </li></ul>