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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

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
  • Transcript

    • 1. Impact on Hospitals
    • 2.
      • Signed into law March 23, 2010.
      • Specific Provisions to be phased in through Jan 1, 2018
      • 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.
    • 3.
      • Reform of private health insurance industry and public health insurance programs.
      • Improve coverage for those with pre-existing conditions.
      • Expand access to care for 32 million Americans
      • Reduce long term costs of the health care system.
    • 4.
      • Quality, affordable Care for all Americans
      • Hospital Value-Based Purchasing Program
      • Incentive for Hospitals to implement EMRs
    • 5.
      • 50.7 Million Americans were without healthcare as of September 2010 (US Census Bureau)
      • An additional 25 Million are underinsured
      • 42% of adults 19-64 are underinsured or have no healthcare
      • 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
    • 6.
      • Hospitals are endangered
        • Most endangered are rural hospitals, and urban ones in areas with excess hospital beds and a lot of poor, uninsured patients.
      • Federal law requires hospitals to provide care for anyone, whether insured or not.
        • It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.
    • 7.
      • “ About 80 percent of the healthcare dollars we spend are used on about 20 percent of the population” –Marna Borgstrom
      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.
      • More insured people means fewer unpaid hospital bills
          • This means less bad debts and uncompensated costs for hospitals.
      • With more people covered, ER ’s could see less OR more crowding
          • The once uninsured will now have a choice for health care and may choose to see a family physician for minor illnesses and injuries.
          • However, Medicaid beneficiaries make up the majority of ER visits.
          • 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.
          • This could mean ER ’s across the nation could see far more crowding.
    • 9.
      • Workforce expansion
        • Yale New Haven Hospital may need additional resources to care for the increase demand for care.
      • North Haven Emergency Center may prove to be crucial.
      • Provides access to neighboring towns
    • 10.
      • Hospital payments account for the largest share of Medicare spending, Medicare is the largest single payer for hospital services.
      • Every year, as many as 98,000 Americans die from errors in hospital care. 
      • 1/3 of Medicare beneficiary discharges will be back in the hospital within a month
      • These medical errors not only contribute to the suffering of patients/families, but lead to increased spending
    • 11.
      • In FY 2013, Hospital Value-Based Purchasing Program will distribute an estimated $850 M to hospitals based on overall performance
      • Funds to be taken from what Medicare would have spent on hospital stays
      • No longer payments based on volume of patients, but based on performance of care.
      • This will encourage quality care improvement, meaning better medical practice and fewer complications and readmissions, which in turn will lower hospital expenses.
    • 12.
      • The Program measures on how closely hospitals follow best clinical practices and how well hospitals enhance patients ’ experiences of care.
      • Examples of the care processes included in the measures:
        • Percent of Heart Attack Patients Given Fibrinolytic Medication Within 30 Minutes Of Arrival
        • Surgery patients who were given the right kind of antibiotic to help prevent infection
        • Patient Experience of Care
    • 13. Yale-New Haven CT Average US Average Patients reported they "Always" received help as soon as wanted. 55% 60% 64% Patients reported their room/bathroom were "Always" clean. 61% 70% 71% Patients reported that area around their room was "Always" 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.
      • HITECH act – authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHRs to improve care delivery
      • “ meaningful use” objectives exist
        • Original proposal – mandatory broad set of objectives to be met (23 for hospitals, 25 for clinicians)
        • “ too demanding and inflexible” – final regulation – two groups
    • 15.
        • Enhanced patient care and safety
        • Lower healthcare costs
        • Improved communication among caregivers and patients
        • Ability to track medical care from home
        • Provides for more efficient hospitals
        • Reduce medical errors
    • 16.
      • YNHS has begun a multi-year process to implement EPIC, a state of the art EHR system
      • EPIC will be implemented by 2013
      • Five-year estimate for building & maintaining EPIC at $250 million
      • Every patient ’s medical record will be available online to each of their healthcare providers
    • 17.
      • It ’s a better way to serve America’s patients
      • Improve the overall health of the nation
      • It ’s a step in the right direction

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