Healthcare Reform Essay

Healthcare Reform Essay
It is important to understand as the years pass by and the time is changing, the world of healthcare is
changing as well, especially in terms of healthcare reform. One major change in healthcare reform
was a course of action that required healthcare organizations to submit mandatory data on the
quality care of their patients. This plan was initiated by the Centers for Medicare and Medicaid in
2015, in which they implemented the Medicare Access and CHIP Re–authorization Act (MACRA).
This act modernized how Medicare payments are tied to quality and cost of care (EClinical, n.d.).
MACRA initially focused on Meaningful Use (MU), PQRS and Valued–Based Modifiers (VBMs).
In fact, when it came time to report quality data, if an organization did ... Show more content on
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As one can see, a decrease in Medicare reimbursements can be a significant deficit for any
healthcare facility. Therefore, the main issue within our private Gastroenterology practice located in
Providence, Rhode Island, is having a full understanding of the recent adjustment implemented by
the Centers for Medicare and Medicaid. Essentially, it is crucial for our organization to learn and
adapt to the new reporting program in order to receive maximum government reimbursements and
not be deemed for any errors. Unfortunately, the new change in quality reporting has added stress to
not just our organization, but also other organizations across the nation. In order to become
proactive, our organization is going to implement an educational program. The purpose is to create
an informative, hands–on program that allows the physicians and administrators to fully grasp
MIPS. The program will contain all the necessary materials to help the individuals have complete
knowledge and awareness of the future of healthcare reform. Consequently, the real issue is to
understand the new MIPS program in its entirety. If healthcare organizations decide to do without
such a necessity, then the issue of MIPS will affect the population health, vulnerable
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Healthcare Ecosystems
Healthcare Ecosystems LLT Task 2 Jacqueline Sanders Western Governors University Healthcare
facilities are required to maintain licensure, certification, and accreditation in order to receive
payments from federal government programs such as Medicare. Healthcare facilities must meet the
minimum standards in order to operate, such as sufficient staffing, personnel employed to provide
services, the quality of equipment, buildings, and supplies, and services provided, including health
records. (LaTour, 2013) Medicare has developed Conditions of Participation and Conditions for
Coverage, which identifies specific criteria that must be met in order to receive reimbursement from
Medicare. Medicare implements these guidelines in order to ... Show more content on
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HIM Personnel play an important role in the Medicare system. Medicare has transitioned from "fee
for service" to providing incentive payments for providers that issue high quality care at affordable
prices. In order to achieve the "pay–for–quality" incentives hospitals and health care officials must
improve their documentation processes. "If it isn't documented, it wasn't done" is more important
than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart.
HIM professionals monitor the quality of documentation and ensure all clinical documentation is
complete and accurate. HIM professionals are the key to identifying process problems while keeping
in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report
quality improvement measures in order to receive payments; HIM professionals can directly impact
Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit
Improvement Act. The HIM professional collects health data that is subject to the audits; HIM
professionals are the point of contact for responding to Medicare audit requests. Medicare laws,
regulations, and processes are ever changing. In order to comply with Medicare changes, HIM
professionals must conform. HIM professionals play a critical

U.s. Health Care System
U.S. Healthcare System On March 23, 2010, the President Obama signed the Patient Protection and
Affordable Care Act (PPACA) which represents the most significant regulatory that impacts the U.S.
healthcare systems. With PPACA, 32 millions of Americans are expected the coverage and
expanded access to health care and medical care. Due to the baby boomers and the downfall of the
economics, there will be millions of people are seeking for low rates medical care which will create
great impact on U.S. healthcare. According to Commonwealth Fund analysis, the U.S. healthcare
ranks last on every cost–related. Therefore, healthcare becomes the top social and economic
problem that American is dealing with. Like all other well–developed countries, there are both
private and public insurers in the U.S. health care system. 'What is unique about the U.S. healthcare
system in the world is the dominance of the private element over the public element' (Chua, 2006).
Healthcare system in the Unites States can be divided into three different groups: Medicare,
Medicaid, and Managed Care. Each plan provides different coverages for different groups of people.
Revenue Sources According to the report conducted by Smith and Madelia, 'the percentage of
American with health insurance for all or part of 2013 was 86.6 percent, and the majority of
individuals, 64.2 percent, were covered by private health insurance' (2014). The majority of people
who receive health insurance through their

The Healthcare Reimbursements Should Be Linked At The...
Executive Summary
The idea that the healthcare reimbursements should be linked to the quality outcomes and
performance measures is central to the Patient Protection and Affordable Care Act. The legislation
provides various reforms that either provide incentives to healthcare providers for better quality
services and outcomes or reduce their payments if certain quality standards are unmet. This paper
talks about the different reforms under PPACA, aimed at introducing payment variations based on
quality of care such as, Hospital Value Based Purchasing (VBP) program, improvements to different
quality reporting programs, payment adjustments for hospital acquired conditions (HAC), reduction
of hospital readmission rates (HRRP), testing for ... Show more content on Helpwriting.net ...
Introduction
United States has no dearth of highly qualified, well–trained doctors and still the US healthcare
quality fails to meet the established industry benchmarks. Institute of Medicine's (IOM's) 2001
Report, "Crossing the Quality Chasm", clearly states that the American healthcare delivery system is
in need of a pivotal change. (Committee on Quality of Healthcare in America (Institute of
Medicine), 2001). The exasperation level is continuously rising amongst both, the patients and the
providers, and yet the problem of delivering and receiving high quality care remains unaffected. In
order to address this problem of healthcare quality improvement and affordability, the Patient
Protection and Affordable Care Act (PPACA or Obamacare) was signed in the year 2010. The main
aim behind PPACA is to improve healthcare quality and accessibility, at the same time keeping it
cost efficient. To facilitate its goal PPACA is trying to achieve the cost effectiveness through
reducing the Medicare price growth and regulating the quantity of care by encouraging evidence
based practices. This new legislation supports the healthcare system in which the goals of both
provider and the patients are better aligned with value as opposed to the quantity of services. Overall
the reform under PPACA seeks to establish a direct link between the payments made to the
healthcare

Medicare On Health Care Case Study
Medicare was created in 1965 to offer assistance to Americans 65 years of age or older or those who
are on Social Security disability. Prior to this, most elderly Americans did not have insurance as it
was not available to them or they could not afford it. Today, less than 1% of elderly Americans are
without insurance or access to medical treatments. Medicare accounts for 20% of healthcare
expenditures, one–eighth of the Federal Budget and more than 3% of the nation's Gross Domestic
Product.1
One way that Medicare impacts the healthcare system is that it sets the price for services rendered.
Since Medicare is so large, most other insurers use this rate as a basis as well. Medicare uses the
Resource–Based Relative Value Scale (RBRVS) to determine

Significant Health Care Event Essay example
Significant Health Care Event: Affordable Care Act
Tiffany L. Boldon
University of Phoenix
Abstract The Patient Protection and Affordable Care Act (PPACA) (ACA) or Obamacare is the most
signification change the U.S. medical system since Medicare and Medicaid reform during the
1960's. The Affordable Care Act or ACA is designed to ensure that all Americans have medical
coverage. It gives those that were uninsured a means to now have health insurance, offers a more
affordable coverage to those who couldn't afford their premiums, expanded the limitations on public
insurance and subsidizes private insurance coverage, and with Medicare, expanded, reorganized, and
reduced cost on some additional supplemental options. Identifying the ... Show more content on
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And another important factor was expanding Medicare and Medicaid options. These two both being
public arenas do service to very different classes of Americans. Regardless of your level of income,
class, or economic status everyone desires to have healthcare coverage and should be entitled to
have it. There are other countries where all of their citizens have healthcare or what is known as
universal coverage, although access to all levels of coverage all the time is not always possible the
idea is still in place. In America prior to the ACA healthcare was primarily supported through
private payers such as individual purchased plans or employer supported plans. The other portion
supported by the government if the patient fit into certain specifications to qualify for such plans.
Buying individual plans of health insurance in most cases is far more than the average person could
afford without having an employer to help supplement the cost; However employers rarely pay
100% of the cost of the healthcare they may provide their employees which still left premium cost
sharing to paid by the employee. Viewing it this way makes it a lot easier to understand why the
number of uninsured Americans was so high. The ACA was designed to give every eligible
American citizen an affordable option for healthcare, even if outside of their employer or if they
didn't fit into the specific criteria of public healthcare.
I think

The United States Healthcare System
The United States Healthcare system is different from other countries for a variety of reasons. Other
wealthy developed countries have a national insurance programs based on global budgets. There are
three basic models for the structure of their National Healthcare Systems. These programs, mostly
cover all citizens in those countries. In contrast, the United States is yet to develop such a healthcare
system. Two programs which impact the United States healthcare system is Medicare and Medicaid.
The United States has different external factors which influence and shape the system. This paper
will evaluate the key differences between the United States healthcare system and other nation's
healthcare systems. The differences between Medicare and Medicaid programs will be analyzed.
Lastly, how managed care reduces the overall cost of care the Florida Medicare form will be
discussed.
The United States healthcare system is influenced by political climate, economic development,
technological progress, social and cultural values, current health trends, and demographics. It has no
central agency to run it and is financed privately. According to the textbook, employers provide 53%
of total healthcare expenditures while the remaining 47% is financed by the government. In the
United States, the majority of the hospitals and physician clinics are autonomous of the government.
Without a central agency to monitor total healthcare expenditures the federal and state government
impact the

The Patient Protection And Affordable Care Act
When Obama was sworn into presidency he implemented many new healthcare initiatives in order
to reform the quality of care and strive forward towards having healthcare be available to everyone.
The Patient Protection and Affordable Care Act was a significant effort to expand healthcare to all
citizens, but the part of the act that is not as well known is the proposal of Accountable Care
Organizations (ACOs). Accountable Care Organizations are an initiative for providing better, more
universal healthcare throughout all stages of life, especially focusing on the care of Medicare
beneficiaries. An Accountable Care Organization is a network of doctors, nurses, hospitals, and
health care providers that all agree to give coordinated care to Medicare patients by having
responsibility of the cost and quality of patient care. The goal of these organizations is to have a
group of people that all know the patient's history and, therefore, through transitions the patient is
able to receive quicker and higher quality of care for less cost of both the patient and provider. The
effectiveness of Accountable Care Organizations depends upon the cost–effectiveness, professionals
voluntarily giving care, and, most importantly, the way in which it affects patient care. The idea
behind this system of coordinated care is great in concept, with the goal of this reform being to have
better valued and quality patient care for Medicare patients. Because of the aspect of patient care, it
is noteworthy

Billing Of Services, Revenue Cycle, And Reimbursements
Within this organization, revenue is generated from the services given to patients and the medication
given to them. Services such as, Social services, dietary, physical therapy, occupational therapy,
speech therapy and nursing services. Medication distributions and ancillary services impact revenue
and reimbursements. The revenue cycle and reimbursements can be interrelated by the fact that sale
of medicines generates revenue and reimbursement will affect the stock. The delivery of services to
patient are also a part of reimbursements and revenue cycle. Since this facility primary financial
resource relies on Medicare and Medicaid reimbursement. Quality of services seems to need
improvements as better services to patients ... Show more content on Helpwriting.net ...
However, the quality of these services seems to need improvements as better services to patients and
proper care for health will impact the revenue cycle and reimbursements. Obama–care supporters
are making the false impression that new government rules would promote opposition, control costs,
and advance the quality of health care delivered within Medicare. Believing that, implementing this
method would concurrently regulate the growth of Medicare costs in a more rational fashion and
close the gap of health care we currently have and the health we would have in our future. No matter
what department is seeking insurance reimbursement, accurate documentation is required along with
proper billing codes to receive timely reimbursement. In 1998, CMS implemented a prospective
payment system (PPS) for Medicare SNFs, replacing the prior fee–for–service reimbursement
system.Under PPS, the Medicare program pays SNFs per day rates, which cover all routine services,
ancillary services, and capital–related costs for a beneficiary's Part A stay. The program pays
different rates for residents according to case–mix adjustments, which are based on residents'
assessments (looking at the severity of residents' medical conditions and skilled care needs). The
payment categories are called Resource Utilization Groups, or RUGs. Medicare pays

The Accountable Care Organization : Help Or Hindrance?
THE ACCOUNTABLE CARE ORGANIZATION 5 The Accountable Care Organization: Help or
Hindrance? Kaiser Health News recently published an article on a new trend in healthcare. This
trend introduces the Accountable Care Organization (ACO). The Centers for Medicare and Medicaid
services defines it as "groups of doctors, hospitals, and other health care providers, who come
together voluntarily to give coordinated high quality care to their Medicare patients" ("Accountable
Care Organization," 2015). According to the Affordable Care Act (ACA), the goal of the ACO is to
be able to share health cost–savings with providers who are able to save money by eliminating
unnecessary procedures and reduce health costs while increasing quality of care. ACOs make health
professionals become more accountable in maintaining good–quality, coordinated healthcare for a
patient through a value–based system that is evaluated through a number of criteria and benchmarks
(Ronai, 2011). The ACO was implemented by the ACA on January 1, 2012. By early 2013, data had
shown that there were 250 established ACOs ("Health Reform Implementation Timeline," 2013).
However, it remains to be seen if Medicare or their providers are really making a difference and
more importantly if the ACOs are helping to drive down healthcare costs. Kaiser Health News
polled several healthcare professionals to find out what is actually going on in the field. According
to most, results are varied but for the most part it seems

Essay On The American Healthcare System
Final Exam Paper
TaeHyuk Hur
American Healthcare System
Northeastern University
Final Exam
TaeHyuk Hur
American Healthcare System Northeastern University
Part 1
Medicare and Medicaid are the largest health insurance system in the United States that provides to
Americans age of 65 or older. It is also provided to certain younger people with disabilities, and
people who are suffering from end stage of renal disease (ESRD). Medicare, Title XVIII of the
Social Security Act, was signed into law in July 30th, 1965 by President Johnson. The program was
originally called "Health Insurance for the Aged and Disabled" [1] There are divided into four parts
of Medicare. Medicare A covers inpatient care in hospital up to 90 ... Show more content on
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[2] It has not been easy to solve problems with a high cost of the health care for many years, but
then, PPACA brought up to improve healthcare system to provide more people to get insured with
lower cost of healthcare or free insurance especially for low income families.
One of these provisions in the Patient Protection and Affordable Care Act was Medicare coverage of
annual wellness visit providing a personalized prevention plan. This provides coverage under
Medicare to have lists of preventive care including a comprehensive health risk assessment and also
include "a five– to ten–year screening schedule; a list of identified risk factors and conditions and a
strategy to address them; health advice and referral to education and preventive counseling or
community–based interventions to address modifiable risk factors such as physical activity,
smoking, and nutrition." [3] It is not only great benefits for people to get healthier and quality life,
but also help saving a lot of money for expensive treatments in lifetime.
One provision that could be improved through Public Policy and Congress is the Hospital
Readmission Reduction Program. According to Center for Medicare and Medicaid (CMS), about
one in five Medicare patient who discharged from a hospital are readmitted within 30 days. There
are many reasons for readmission such as severity of one's illness, person's physical or mental
ability to understand and follow discharge instruction or

Medicare Spending Report
The report on Medicare spending provides relevant information about the United States healthcare
system. It further provided ideas of how the U.S healthcare system is using drastic measures that
limit cost, increase quality of care and focus on patients' care. From the report, it appears that the
U.S federal program Medicare had reduced its spending to 0.2% in 2013 as compared to 1.8%
between the years 2009–2012. The article supported its claims of Medicare spending reduction by
citing statistical data from Medicare budget reports. As mentioned in the article, the decrease in
spending could have resulted from the recent recession (hardship limit spending), Medicare wide
range of delivery system reform to implement quality at a local cost or

Essay On Hospital Revenue
Patient Satisfaction Impacts Revenue The purpose of this paper is to discuss how patient satisfaction
impacts hospital revenue. As hospital reimbursements are now closely entwined with patient
satisfaction, a patient's experience affects hospital revenue. With more transparent platforms such as
patient experience survey results being publicly available and having a new national value–based
purchasing system in effect, it is imperative more than ever to comprehend how such metrics impact
a patient's hospital admission. This paper will focus on how those metrics play a pivotal role on the
patient experience and its impact on hospital reimbursement. Traditionally, hospitals have been paid
according to patient volume, however, with the ... Show more content on Helpwriting.net ...
Another tool, which stemmed from the ACA, is the Hospital Value–Based Purchasing Program
(HVBP), in which CMS rewards hospitals with incentive payments for the quality of care they give
to patients. More specifically, CMS withholds participating hospitals' Medicare payments by a
percentage in accordance with law if their performance is not within expected standards. Those
reductions are then used to fund value–based incentive payments to hospitals based on their
performance in the program and then it applies the net result of the reduction and the incentive as a
claim–by–claim adjustment factor to the base operating Medicare severity diagnosis–related group
(MS–DRG) payment amount for Medicare fee–for–service claims in the fiscal year associated with
the performance period (CMS.gov). Value–based purchasing aims to ultimately improve the delivery
of care through its direct financial implications in hopes of adequately being the drive needed to
change the culture of healthcare. CMS has raised the bar on quality and patient perception of care,
making it vital for hospital organizations to abide by measures that will help secure its
reimbursement. In conclusion, with revenue at stake, hospital administrators are constantly looking
for strategies to enhance the

Summary: The Future Of Medicare
Medicare has changed the healthcare industry considerably and is one of the largest health programs
in the world. With its spending of $260 billion a year, it only accounts for 17% of health
expenditures. Even though Medicare has led to better care there is also the need for continuous re–
evaluation. Since its introduction in July 1965, and with a ten–year study, the impact on elderly
mortality was tremendous. When first signed into law, it only included hospital care and doctor
services. Even though our elderly were finally getting the insurance they needed, they still had to
pay for their medications in full which contradicted with the care they required. In 2003, Congress
approved what is known as Medicare part D which allowed for Medicare participants a prescription
drug benefit. Up until this point one–quarter of beneficiaries had no coverage for their medications.
Which is a crucial part of their healthcare. There are two plans under Part D, Prescription Drug Plan,
for drug coverage only, and Medicare Advantage plan, which covers both medical services and
prescription drugs (Poisal J., 2000). ... Show more content on Helpwriting.net ...
Some will come from explicit policy and legislative initiatives, but others will reflect the rapidly
changing nature of the health care system as a whole. Medicare cannot be understood or
administered without an appreciation for its interrelationships with the American health care system.
An aging society will inevitably put pressures on the program that will require new approaches and
new funding. Even though funding is an issue, in my opinion this is still a positive impact for
healthcare. Something this big that helps so many elderly and disabled, can be nothing but positive
Most of our grandparents, or even parents, rely on Medicare for their doctors' visits or medications.
Which is why it is vital that we try and save this program so they can be here for us in the

Healthcare Plan For A Universal Healthcare Program
Section 1: Summary
Medicare has had many legislative changes to modernize the program since it was first signed into
law. Medicare has assisted many retirees from a financial disaster by providing benefits during a
healthcare crisis. The prescription drug program has ensured seniors have access to the medications
they require. Medicare has also provided care to the disabled that are under age 65. This national
social healthcare program has also come under fire politically because of the extremely high cost of
the program.
The baby–boomer generation is aging and adding more beneficiaries' at an increasing rate than ever
before and is estimated to impact the federal deficit by over 17% by 2020. Many other countries
have National Healthcare that provides better care at a much lower cost. Medicare was the
motivation for a universal healthcare plan and a program for the U.S. could have a positive impact.
(Starr, 2011).
The Medicare program is being perceived that it will go bankrupt in about 10 years unless there is
major reform. There are six recommendations that should be reformed for the protection of the
program for future generations. The program must protect retirees from an economic healthcare
disaster. The cost of the program must be shared and this will motivate benefactors to reduce cost by
adding accountability to the program. Reducing Medicare expenditures will have a much larger
impact than increasing taxes. Calculating the retirement age in correlation to life

Healthcare Systems And The United States
Healthcare systems in the United States are very complex. The United States healthcare system is
made up of public and private components. Medicare, Medicaid, private insurance, government run
healthcare systems, and military coverage is reviewed. As of 2011, 15% of Americans are uninsured,
60% of insured are employer based, and 15% are covered by Medicare. Access to medical care still
has its challenges especially for the uninsured or underinsured. Although the United States spends
the most on healthcare and has access to the best technology and healthcare services for Americans,
the quality of care is not significantly better than other countries. Financing and Resources are two
of many internal factors and emerging medical technology are on of many external factor discussed,
and their relationship to Access, healthcare expenditures, and quality. Improving quality of care
delivery by increasing care coordination, reducing the growth of costs, and moving away from fee–
for–service delivery toward rewarding quality and value is needed. The United States is going to
need to work toward price regulation, decreasing healthcare expenditures, and improving quality of
care and outcomes, so that all Americans in the future will have healthcare coverage.
The United States Healthcare System is quit complex and is similar to that of other countries.
Access, health care costs, and quality of care, and how they relate to internal and external forces will
be

The United States : A Single Payer System Essay
The United States is one of the richest countries in the world, yet the health care system is not
something that the government wants to pay for. The United States has private insurers that pay for
health insurance, instead of being a single–payer system like a majority of the world. A single–payer
system is when the Government pays for the health insurance without the help of private insurers.
Although it is not the best, health care in the United States has improved. An earlier practice of
medicine was when anyone could perform medical needs like surgery. You did not need to pass any
board exams or need a license. In the 1850s, there was a hospital system that was finally developed,
but the only problem was that the care provides were untrained. In 1847 the American Medical
Association, AMA, was created to set standards of medical education. Public health also changed in
the 1800s with three important events happened. Those events included Edwin Chadwick, who
founded one of the most important documents in public health, General Report on the Sanitary
Condition of the Labouring Population of Great Britain. John Snow then did research and founded
that the contaminated water in London was the cause of the cholera epidemic in London. And then,
based of off Chadwick's and Snow's findings, Lemual Shattuck generated a public health law that is
now the foundation of the public health movement. In the 1950s, there was government grants that
helped support medical schools. In 1970,

Healthcare Delivery: Article Analysis
The scope of healthcare is continually changing. There still seems to be a continuation of issues
within the aspects of healthcare delivery. Since 2005 there has been several Committee meetings on
this dyer issue and they have come up with some interesting ideas on this matter, but neither one has
been the one to fix the aspects of the problem. When it pertains to the efficiency and effective
aspects of the quality of care and how it is perceived when it involves the delivery of healthcare
service. The top five elements that I have noticed throughout the reading of these two articles that
need to be improved upon to increase efficiency and quality are as follows:
1) Creating pressure for efficiency through payment updates, 2) Improving payment ... Show more
content on Helpwriting.net ...
Ex. Setting a benchmark of 100 percent and if it is exceeded the provider will end up being
penalized. Reason being is to cut down on overpayments and retain high quality and low–cost
payment for individuals who have Medicare.
Improving payment accuracy within Medicare payment systems (improve the accuracy of DRG
patients to patients by eliminating distortion between facilities that specialized in providing limited
service to individuals that were involved in DRG programs). Ex. Clinicians who provided primary
care services would obtain and increase in fee for service.
Linking payment to quality (Putting and incentive for Medicare to only pay for quality of care ad
Physicians receive payment for quantity of service given). Ex. Setting standard for dialysis services
to control Medicare spending.
Measuring resource use and providing feedback (Each physician would measure their care and give
access to each other while giving suggestion on ways they can improve upon the induction their

The Health And Affordable Care Act ( Ppaca )
The healthcare sector in the United States is a unique and complex when compared to other
industrial countries. The government had spent $ 1 trillion on health programs; $600 billion for
Medicare, $400 billion for Medicaid, and had a budget deficit of $486 billion in 2014. In an attempt
to reform healthcare, there have been several initiatives throughout its history to improve care
delivery, quality, and outcomes. A significant reform was enacted in 2010, the Patient Protection and
Affordable Care Act (PPACA), also known as Obamacare. Despite the benefits included in the
PPACA, there were several disadvantages, and eventually it was not comprehensive enough to fix
all the healthcare issues. In order to achieve best healthcare policy in the U.S., it requires a better
understanding of its stakeholders, components, and issues. A comprehensive policy should consider
the following components: payment, access, health education, preventive care, and government–
sponsored programs, to be effective and efficient. Any proposed policy to improve healthcare must
address the current payment method, and the rising cost of healthcare. The common reimbursement
method for healthcare services is the fee–for–service payment model. It requires providers to figure–
out all incurred costs to render services for patients. Additionally, providers need to determine what
is the insurer proposing to pay, which thought to reward quantity over quality. An alternative to this
model is using a bundle

Trinity Community Healthcare Case Study
Trinity Community is challenged with two current healthcare trends. The first trend is related to
Medicare and how doctors are paid on Medicare claims. Medicare's primary coverage group is for
people older than 65 years of age. Medicare also covers some people under 65 that have certain
disabilities as well as people of any age that have End–Stage Renal Disease. Year after year,
lawmakers have been trying to fix a part of the Medicare law that would cut payments to doctors.
Since the late 1980's, the cuts would continue to grow annually and eventually exceed a 20% pay
cut. When Medicare was signed into law in 1965, it was a fee–for–service based system. Basically,
the more services that doctors performed, the more reimbursements received ... Show more content
on Helpwriting.net ...
Legislation The imposed cuts to Medicare's fees schedule for physicians, known as Medicare
Sustainable Growth Rate (SGR) formula, were permanently ended as part of new legislation called
the Medicare Access and CHIP Reauthorization Act of 201, aka the "doc fix" bill, was signed on
April 16, 2015. The new bill would replace the current reimbursement schedule with a five year plan
to provide automatic pay increases to physicians. The focus of the new payment system is value,
accountability and quality and would become a Merit–Based Payment Incentive System (MIPS). A
physician's assessment for reimbursement would be based on four core metrics; quality, clinical
practice improvements, resource use, and meaningful use of EHR. The lowest performing
physicians would have their reimbursements cut by nine percent. (Wynne, 2015) This bill doesn't
come without a price tag of its own. Approximately $141 billion dollars will be tacked on to the
federal deficit. For enrollees of Medicare, the premium structure has changed. See the Table 1 below
for premium costs based on

Medicare: The United States' First Medical Social...
Merriam–Webster dictionary defines social insurance as, "protection of the individual against
economic hazards (as unemployment, old age, or disability) in which the government participates or
enforces the participation of employers and affected individuals" (1). The United States government
operates several national social insurance programs. Medicare is the United States' first medical
social insurance program. This program was designed to provide health insurance to the elderly and
protect them from financial hardship due to illness. A thorough investigation of this program reveals
the overall history, financial cost, and the total effect that it has had on the healthcare system. The
idea of a national healthcare plan was first introduced in 1945 by President Harry Truman. Although
President Truman was unsuccessful in creating a government administered healthcare program, he
was successful in bringing attention to the issue of healthcare in the United States. In 1965 the
United States' Congress passed a bill approving the Medicare program. This program was designed
to allow the country to provide elderly citizens access to affordable medical care. This bill was
signed into law a few days later by the 36th president, Lyndon B. Johnson. After signing this bill
President Johnson stated, "We marvel not simply at the passage of this bill, but that it took so many
years to pass it."(Forty Years of Medicare 1). Finally, twenty years after President Truman first
proposed a

The Medicare Funding Crisis : Congressman Hughes
The Medicare Funding Crisis
Congressman Hughes,
You have been invited to participate in a panel discussion to address the Medicare Funding crisis.
The panel has asked you to respond to a proposal to enroll participants in HMO's to reduce
Medicare expenditures. I have taken the liberty to prepare the following responses for the panel
discussion.
Eddie Acosta, Chief of Staff
Introduction
Ladies and Gentleman, many of you are concerned of losing your medical entitlement and if
something is not done as soon as possible, the Medicare program will be bankrupt by 2021.
Medicare has been scrutinized on how the system is funded and in its comparison to the results of
health outcomes as more people are enrolling into the system. It is very difficult to address the
federal deficit, our national debt, Medicare, and many economic issues that plague our country.
There are many opportunities that are in front of us to reach a resolution in an attempt at saving this
healthcare entitlement. I am very concerned on the lack of information on this issue and also the
amount of misinformation that is being distributed. I appreciate your invitation to speak at this panel
and I will address your concerns about the Medicare Funding crisis. (Roy, 2011)
Is Medicare in a state of crisis? Are radical measures necessary to preserve the program? Medicare
is absolutely is a state of crisis and if we do not make the necessary modifications to this medical
entitlement, there will not be a Medicare

Meaningful Use For Nurses : Implications And Recommendations
Meaningful Use for Nurses:
Implications and Recommendations The use of health information technology has evolved over the
years to become an integral part of the patient care. Note to mention that technology in healthcare
initially was driven by hospital shared accounting system, then, it changes to drugs and
reimbursement program. The system has expanded to the point that at the corner of 21 century,
health technology is different from what it was before. Meanwhile, complementary technologies
integrate the system. It started with electronic medical record (EMR) and progresses to electronic
health record (HER) or e–health that involves the use of computer and other computer–based
devices to collect, store, and retrieve data that are in turn transformed into information for
meaningful use; thus, the term of health information technology (HIT). In attempt to forecast
meaningful use of health information technology, it is possible to list other emerging health
information technology devices, such as mobile health (m–health) and ubiquitous health (u–health)
that will not be part of the discussion in this paper. For the record, meaningful use of electronic
health record is based on care outcome reimbursement, whereas any clinical decisions should aim to
support quality care at a low cost. Thus, providers, nurses, and other health disciplinary team should
aim their daily practice towards the pillars of care outcomes that are the attributes of meaningful
use. For this

Medicare And The Elderly Of The United States
The quantity of Medicare eligible individuals continues to grow as the median age of the population
of the United States rises. The old Medicare system has become outdated and strained because of the
volume of individuals that are currently receiving benefits within the program. Since the enactment
of the Affordable Care Act (ACA), Medicare has become the main source of delivering healthcare
insurance for the elderly of the United States. In order to meet the current requirements of the ACA,
Medicare must be reformed in order to provide the promised services for the individuals that are
currently receiving benefits and for the future survival of the program.
Medicare was established by the federal government to provide healthcare insurance initially for the
elderly and included the disabled a few years after the program's inception. As of 2013, there were
52.3 million beneficiaries of Medicare, with an average of $11,910 spent on each individual for
healthcare, with a total annual budget of $582.9 billion (NCPSSM, 2015). Medicare is funded
through two trust fund accounts that are held by the U.S. Treasury: the Hospital Insurance (HI) and
Supplementary Medical Insurance (SMI) Trust Funds (Medicare.gov, 2015). These trust funds are
financed by payroll deductions, Social Security benefit taxes, premiums paid by Medicare
beneficiaries, interest from investments, and funds furnished by Congress (Medicare.gov, 2015). All
of these resources subsidize the Medicare Trust Fund in

Market Competition In Healthcare
Introduction For several decades, economists, policymakers, and healthcare experts have argued on
the inefficiency of the healthcare industry has been insulated from the competitive market forces
operating in the midst of the economy. On the contrary, the healthcare receivers continued to be
uninformed of the quality of healthcare they deserve and the government policies and programs that
are responsible for the maintaining the quality. In fact, there are multiple ways of improving the
quality of the healthcare and decrease the cost. The competition in the market is one of the important
force responsible for improving the quality of the healthcare services while reducing its cost. On the
other hand, competition is unhealthy for hospital economy ... Show more content on Helpwriting.net
...
In the second study by Chandra, Finkelstein, Sacarny, and Syverson (2016) that assessed the
productivity in the healthcare sector and compared that to the other manufacturing industry.
Productivity dispersion measures the variations in productivity among the different players in the
market (Syverson, 2017). If the productivity dispersion is larger in the healthcare industry, the
exceptionalism would argue that the impact is that one will likely find both low and high
productivity in the healthcare players in the same industry. In the healthcare sector, the productivity
dispersion is large, and the study demonstrated that from its research on Medicare patients treated
for (AMI) acute myocardial infarction. For the AMI patients at 90th percentile healthcare centers the
survival rate was 1.55 times higher as compared to those treated at 10th percentile healthcare centers
(Chandra, Finkelstein, Sacarny & Syverson,

Poverty In Health Care
Poverty economical effects take many forms. Poverty's impact can be seen in the healthcare
industry. The cost of healthcare has resulted in 100 million individuals in 116 different countries to
being pushed into poverty. Another 150 million people have living standards drastically altered due
to the cost of out of pocket medical payments (Alam & Mahal, 2014). Some nations such as Uganda
has seen impoverished individuals being forced to endure 50% of health–related expenses coming
from out of pocket expenses (Kwesiga, Zikusooka, & Ataguba, 2015). Many nations subsidize the
health systems for citizens in an attempt to prevent the weight of unexpected health care from
crumbling individuals and families economically. The United States spends ... Show more content
Unemployment is considered the key indicator of a nation's economy and high unemployment rates
will send shock waves through the economy. Unemployed individuals don't have expendable
income which translates to a cut back in non–necessary spending which means a loss of sales tax
revenue. The fewer individuals with decent paying jobs translate into fewer individuals making
investments due to fear of financial security. Nations that are not financially stable creates a
financial system with little confidence within the marketplace which will lead to a downturn in stock
market value. Unemployed individuals are not paying state and federal taxes but instead sucking
money out of the economy. Unemployed people will utilize unemployment insurance which will
increase state deficits. Increases in unemployment insurance claims cause states to raise taxes to
make up for the lost revenue created from unemployment. 45% of mortgage foreclosures is created
by unemployment. Unemployment propels bankruptcy rates and foreclosure rates to rise. High
foreclosure rates will lead to home values to fall. The impact of poverty is vast as nations have to
raise taxes to absorb the impact which will create an economic spiral which will decrease
investment, drive down the stock market value, slow spending due to concerns about financial
security which translates to poor economic growth (Hudson,

2012 Election: The Great Medicare Debate
2012 Election: The Great Medicare Debate
Since 1965, Medicare has been attempting to provide low cost, guaranteed access to much needed
healthcare for senior citizens over the age of 65 and other age groups that suffer from disabilities
and terminal diseases. These people represent some of the most vulnerable population groups in the
United States. Most do not work, and rely on Medicare to provide them the access to healthcare they
need. Unlike privatized health insurance companies, Medicare is a social insurance program that is
paid for through federal mandates and tax payer funds. Billions of dollars are spent annually on over
50 million Americans in need (Alonso–Zaldivar 1). The care structure itself is broken into several
main parts: Medicare Part A covers hospital costs, Part B cover most outpatient care costs, and Part
C and D cover prescription drug costs through dealing with other private insurance. Yet, the
upcoming election in November is threatening to change and alter the structure. Each candidate has
his own plan to deal with Medicare; both are trying to reign in the costs of operating Medicare, but
with some elements being obviously more beneficial for Medicare recipients than others. Mitt
Romney is the Republic presidential candidate who wants an overhaul of Medicare in order to keep
costs down. Romney's approach is based off his running mate Paul Ryan's suggestions. According to
the research, "Romney officials say Medicare savings will come through

Healthcare Rating Essay
Healthcare has been an every changing service as different leaders have tried to find better ways to
streamline the system as costs continue to increase on an annual basis. One thing is becoming clear
as Healthcare continues to evolve in that Healthcare is moving to a performance based system in
which higher performing plans will get financed a lot quicker than low performing plans.
As an example, CMS (Centers for Medicare & Medicaid Services) uses a five–star quality
performance rating system to measure Medicare beneficiaries' performance experience with their
health plans and the health care system. This rating system applies to all Medicare Advantage areas
of business: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO),
plus it also applies to Medicare Advantage plans that cover both health services and prescription
drugs (MA–PD). The program is a key component in financing health care benefits for MA and
MA–PD plan enrollees, and the ratings are posted on the CMS consumer website to ... Show more
I think this trend will continue to be present as costs increase along with adding more people with no
coverage to an already overloaded system. I have also found it harder to find new Doctors including
making appointments, plus prescription medicine costs are increasing as well.
As Healthcare moves forward, I like the idea of having performance based plans with CMS being a
governing body as the goals try to address the biggest issues in HealthCare today. The goals for the
CMS Rating System are, implement provisions of the Affordable Care Act, clarification of program
requirements, strengthen beneficiary protections, and strengthen CMS' ability to distinguish stronger
health plans for participation in Medicare Parts C and D and to remove consistently poor performers

Healthcare Ecosystems Task 2
Running head: HEALTHCARE ECOSYSTEMS TASK 2
Healthcare Ecosystems Influence by Government Regulations, Legislation,
And Accreditation Standards
Iona R. Heffley
Western Governors University
1
HEALTHCARE ECOSYSTEMS TASK 2
2
Healthcare Ecosystems Influence by Government Regulations, Legislation,
And Accreditation Standards
Medicare is a national government–sponsored insurance program in the United States. Created by
Congress in 1965, under President Lyndon B. Johnson, Medicare guarantees access to health
insurance for Americans that are aged 65 and over and younger people with disabilities. It was the
primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent
($182.7 billion) of total aggregate ... Show more content on Helpwriting.net ...
Medicare contracts with regional insurance companies process over one billion fee–for–service
claims per year. In 2008, Medicare accounted for 13% ($386 billion) of the federal budget. In 2010,
it is projected to account for 12.5% ($452 billion) of the total expenditures. For the decade, 2010–
2019
Medicare is projected to cost 6.4 trillion dollars or 14.8% of the federal budget for the period
(Budget of the United States Government, 2009).
HEALTHCARE ECOSYSTEMS TASK 2
5
Medicare Influence on Patient Access to Care
There have been serious concerns during the Health Care Reform, that seniors would lose access to
doctors who treat Medicare patients. But, in a briefing issued by the U.S. Department of Health and
Human Services in August, 2013, the federal government said the percentage of all "office–based

physicians" accepting Medicare patients hasn't changed significantly between 2005 and 2012 (as
cited in Japsen, 2013). The brief also reported that the number of physicians accepting Medicare
rose from
2012 to 2013.
Contrary to that brief, Japsen (2013) states that the American Medical Association said patient
access to physicians who treat Medicare patients is still an issue.
Health Informatics in the Medicare Process
Health informatics is mandatory in virtually every aspect of health care today. Requirements and
demands from federal

1
HEALTHCARE ECOSYSTEMS
RLTT: Task 2
2
HEALTHCARE ECOSYSTEMS
PACE and Telemedicine
All–Inclusive Care for the Elderly otherwise known as (PACE) is a benefit program provided by the
Centers for Medicare and Medicaid Services (CMS) for patients that are 55 and older and can be
nursing home certified. CMS works with state administering agencies to operate a PACE program in
their respective state. PACE is only provided by states that choose to offer the program under
Medicaid provisions. PACE is a benefit provided by Medicare and is optional with those having
Medicaid. As one of the only programs that combine Medicare and
Medicaid, the PACE objective is to keep the patient living in their communities ... Show more
The new ICD–10 coding system gives more specific choices for diagnostics and will ensure services
are paid appropriately to reduce fraud and overpayments.
The transition from ICD–9 to ICD–10 is required for everyone covered by the Health Insurance
Portability Act on October 1, 2014. According to the Health and Hospital Systems Secretary,
Kathleen Sebelius, "The new healthcare law is cutting red tape, making our health care system more
efficient, and saving money".
Standards
The standards set for the PACE program are very stringent. The certification process requires and
application, on–site visits, and information provided by the state agency. The application process
can take up to nine months and once accepted, the first three years are considered a trial period.
Within the trial period, the PACE program is reviewed annually by the state administering agency to
ensure compliance with the federal regulations and every two years after that. Compliance is vital to
maintain participation in the PACE program. Any violation of the regulations will bring about
suspension of enrollment of beneficiaries, penalties, and/or suspension of payments. The PACE
program basic requirements state that it must be able to provide a complete healthcare service
regardless of the amount of care needed or the time a service takes (PACE– fact sheet, ).
Telemedicine offers a way to provide service and is growing in importance as part of the complete

Government Health Insurance Medicaid and Medicare
Government Health Insurance Medicaid and Medicare
HCS/531
03–16–2013
Dr. Dorothy Cucinelli
Government Health insurance Medicaid and Medicare
In today's society concerning health care there are many aspects. These aspects are not limited to the
provider, the patient, and the financial aspect. The aspect that is found quite interesting is the
financial aspect. To be more specific about the financial aspect, this paper will cover the healthcare
insurance. Healthcare insurance comes in different forms whether it is private, employee–based or
government insurance, A significant event that has brought among change in the Healthcare system
is ... Show more content on Helpwriting.net ...
1966–Medicare was implemented on July 1, serving more than 19 million individuals. Medicaid
funding was available to states starting January 1, 1966; the program was phased –in by states over a
several year period.
1967–An Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) comprehensive health
services benefit for all Medicaid children under age 21 was established.
1972–Medicare eligibility was extended to 2 million individuals under age 65 with long–term
disabilities and to individuals with end–stage renal disease (ESRD). Medicare was given the
authority to conduct demonstration programs (Healthcare Finance... 2005). Medicaid and Medicare
today Every year the number of beneficiaries increases. The pressure to gain control of Medicaid
program spending, which has consumed an ever–larger share of state budgets, increased during the
recent economic downturn. Nearly a quarter of the U.S. population, or 77.5 million people, were
enrolled in Medicaid or the Children's Health Insurance Plan at some point in 2011, according to the
March 2012 report of the Medicaid and CHIP Payment and Access Commission.(modern healthcare,
2005)
Conclusion
In conclusion this government–based health insurance has only been around almost 50 years. The
time before this must have been very difficult on society when it came to their

The Role Of Registered Nurses
Throughout time there have been many historical and political factors that have influenced the
Australian healthcare system and shaped the role of Registered Nurses. As healthcare professionals
within this system, it is important for RNs to maintain a contemporary understanding of key
influences. For example, Florence Nightingale is one of the main historical factors which has played
a major role in impacting the way nursing is approached and how nurses can advocate for patients to
provide a proper caring and healing environment for patients and their loved ones. Another
influencing factor being political is Medicare. Medicare is another major influencing factor that has
shaped healthcare and healthcare access in Australian society. The ... Show more content on
Helpwriting.net ...
To clearly present the growing sanitation issues, Nightingale used her mathematical knowledge and
drew static graphs which proved her hypothesis and was accepted by the Royal Commission which
allowed for her ideas of improved sanitation to be implemented within hospitals as it verified that it
did in fact improve the conditions of patients' health and decrease the mortality rate (Wakely &
Carson, 2012). Since the time of Florence Nightingale, it was made possible for nurses to be valued
members of society who not only promote patient well–being but also provide a safe and caring
environment for the healing process. Nightingale found that effective use of patient advocacy
greatly enhances the care–giving environment (Reed, Fitzgerald & Rae, 2016). Through the study of
Nightingale's many letters and publications, researchers have been able to identify her professional
goals and successful techniques, that she was one who valued populist human rights and created
authority standards and practices that give helpful support systems to nurses practicing in the 21st
century (Wellard, 2014). Florence

The Cost Of Healthcare And Healthcare
The cost of healthcare and healthcare spending is a key component of any developed economy in
that with good facilities there is a good source of human resource. Considerate health spending leads
to the development of medical technologies and drugs hence satisfying fundamental social and
individual demands for services that brings greater productivity, improved health, and longer lives.
As compared to other sectors of the economy in the USA, health care is publicly funded. According
to Organization of Economic Cooperation and Development (OECD) public spending in the United
States of America accounted for almost half of total spending in the year 2011 as compared to 60–80
percent in other developed countries. The American society is currently grappling with exorbitant
health care charges that have plagued the public; the high cost of health care services has been an
issue that the ruling class has been grappling with. It has taken both political and social dimensions
especially with the agitation of the Obamacare health plan when Senator Obama came into power.
The focus of this discourse, though, is not to get into the political and social vagaries of the
healthcare system, but rather to focus on the salient issues related to affordable care act (ACA) the
American republic. Affordable Care Act (ACA) or the Patient Protection and Affordable Care Act
(PPACA) The act, which is often nicknamed Obamacare, is the new health care reform law in
America that is made up of the patient

Affordable Care Act Impact On Healthcare Practice
Affordable Care Act Impact on Healthcare Practice
If I were to assume the role of a political official, I would point out several of the benefits of the
Patient Protection and Affordable Care Act (ACA) and try to convince public opinion that
ultimately, it serves their best interests. The ACA impacts patient experiences by focusing more on
optimal health outcomes while reducing costs and increasing quality.
The ACA influences many components of the healthcare delivery system, some of which are patient
centered care, cost, quality, and the general population. In the ACA, patient centered care is
emphasized and the "ACA repeatedly refers to patient–centeredness, patient satisfaction, patient
experience of care, patient engagement, and ... Show more content on Helpwriting.net ...
For example, the ACA includes "Sunshine" provisions which require reporting of all financial
transactions and transfers of value between manufacturers of pharmaceutical/biologic products or
medical devices and physicians, hospitals, and other covered recipients that are reimbursed by the
U.S. federal government (Sultz & Young, 2014). This can prevent bias physician decision making
and forces providers to openly report and disclose relationships and affiliations formally. As
physician and ethicist Howard Brody states, "The real goal of Sunshine legislation is to attack the
total amount of influence that the pharmaceutical and device industries exercise over medical
research," and thus over practice that is based on that research (Brody, 2007).
A way that the ACA impacts quality of care is through increased access to care. Patients can no
longer be charged more or denied coverage because of a pre–existing medical condition. Prior to the
ACA, the U.S. healthcare delivery system was inefficient with health risks and careless
expenditures. One example would be a patient that is given different prescriptions from multiple
doctors, risking dangerous drug interactions. Another example is demonstrated in the decrease in
hospital readmission rates. Patients are susceptible to hospital acquired infections the longer they are
admitted, and readmissions and

PPACA Impact
The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare, or the
Affordable Care Act (ACA), is a United States federal statute signed into law by President Barack
Obama on March 23, 2010 (Martin, 2015). It is designed for Americans to have insurance or be
penalized with 1% of your income for the beginning of last year and will raise up towards 2.5% by
the beginning of 2016. Also, health care reform was created to fix our health care systems since the
cost of the systems is increasing every year in price. The goal of ACA is to help out the insured with
being provided with quality care through health care organizations. Thus the ACA is intended to
prevent the uninsured from catastrophic medical expenses which not only ... Show more content on
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Implementing this law will not only change the health care organizations as a whole but also give
people a sense of urgency that it will help them get insured so they can be provided with service
when they are in dire need of care. Improving access to care should return improvement in the
overall population health, increase in how the employees bring motivation and better production,
and reduce the significant risk of the uninsured individuals that will give them a position as an
insured model that will represent those that are insured and will able to provide service with their
health care plans for their family. The health care law brings about a better change for health care
providers and also to people who were previously insured. It helps out the families because they can
get provider with quality care and also receive medication for any type of health issues they may
have had over the years of being

Medicare Pros And Cons
Introduction This paper explores the controversy within Medicare and examines multiple articles
about this topic. Discussing the pro's and con's of this healthcare program that has affected
Americans in the 1960's to the present day. Medicare has had a large impact on American society
even throughout it's many challenges. Many say that the 1965 enactment of both Medicaid and
Medicare was a one of the greatest post war government achievements since it provided care for not
just those 65 and older, but the disabled as well. At the National Council of Senior Citizens
President Lyndon B. Johnson stated, "Medical care will free millions from their miseries. It will
signal a deep and lasting change in the American way of life. It will take its ... Show more content
The biggest challenge for the Medicare program is updating the benefit package to reflect what is
available for the private sector. Coverage's that need the most updating are outpatient prescription
drugs. Health care providers (doctors, hospitals, etc.) often have a less than perfect grasp of
Medicare coverage and beneficiary rights. Medicare usually requires providers to make the first
decision as to coverage, but the system includes financial costs and penalties that discourage the
award of coverage. Even helpful providers may have incomplete knowledge of the potential scope
of coverage (Dale & Feuerman, n.d). Based on an article authored by Antos (2013), for many of the
6 million MA plan holders, Medicare will fundamentally change or disappear as companies respond
to the 7 percent to 8 percent cuts. In 1997, the Balanced Budget Act of 1997, pushed through by a
Republican Congress, included serious payment cuts to private plans in Medicare, which in just six
years caused the number of participating plans to drop in half. In 2003, Republicans passed
legislation guaranteeing private providers higher payment than traditional Medicare. Lowering these
payments may be necessary. The 7 percent to 8 percent cuts the Obama administration plans to
implement amount to the Medicare version of sequestration.

Hcs 440 Economics: the Financing of Healthcare
The purpose of this paper is to review and discuss the current level of national healthcare
expenditures and to determine if we as Americans are spending too much on healthcare. The author
of this paper will provide examples and solutions where we as a nation should add or cut from the
healthcare expenditures. This paper will also detail how the general public's healthcare needs are
being paid for, the biggest economic healthcare challenge, why the challenge should be addressed,
and how this challenge to be financed. The current level of national healthcare expenditures The
National health expenditures is defined as any funds spent on and for healthcare services. Healthcare
funding consists of individual, public, and ... Show more content on Helpwriting.net ...
The biggest economic challenge for the health care system in the upcoming decades The main
economic challenge for the healthcare system in the United State will be the rising expenses
associated with Medicare and Medicaid. The Governments share of healthcare spending is predicted
to rise to 31 percent by the year 2020 (Keehan, Sisko, Truffer, Poisal, Cuckler, Madison, Lizonitz,
and Smith, 2011). This may jeopardize the economic stability and financial security of the nation.
Why this "challenge" has to be addressed The problem of rising healthcare costs is to be addressed
because of its nation–wide significance. Predictions given by economic analyst suggest that funding
for Medicare will run out of money and will not be operate–able by the year 2024 if government
remains the major payer for healthcare and the costs of Medicare continue to rise. Government will
not be able to continue financing the healthcare system on its own (Gersh, 2011). How will this
challenge be financed? Continued increases in healthcare spending can negatively impact all sectors
of the economy (Sood, Ghosh, and Escarse 2007). Budgets are currently limited, so an increase in
healthcare funding could mean a reduction in funding to other areas such as education, and
businesses, or may cause the government to increase restrictions or raise taxes (Sood, Ghosh,

Healthcare Quality And Affordable Care Act ( Ppaca )
United States has no dearth of highly qualified, well–trained doctors and still the US healthcare
quality fails to meet the established industry benchmarks. Institute of Medicine's (IOM's) 2001
Report, "Crossing the Quality Chasm", clearly states that the American healthcare delivery system is
in need of a pivotal change. (Committee on Quality of Healthcare in America (Institute of
Medicine), 2001). The exasperation level is continuously rising amongst both, the patients and the
providers, and yet the problem of delivering and receiving high quality care remains unaffected. In
order to address this problem of healthcare quality improvement and affordability, the Patient
Protection and Affordable Care Act (PPACA or Obamacare) was signed in ... Show more content on
Helpwriting.net ...
b) Large variation exist in the per capita healthcare expenditure across the United States which can
be attributed to difference in healthcare services provided due to absence of evidence based
treatment. c) Overuse and misuse of healthcare services are proving to be costly, pervasive and
causing harm to the patients.
Stakeholder Analysis
The triple aim of PPACA to promote accessible, high quality and cost efficient care involves large
number of reforms that influence all the segments associated with healthcare industry. These
reforms are affecting various stakeholders such as hospitals, physicians, and patients to varying
degrees and therefore policymakers need to consider independent stakeholder priorities along with
the impact on society and cost involved in order to achieve this triple aim. The Affordable Care Act
introduces payment reforms for individual physicians and for larger, organized health care systems,
ranging from bundled payments to payment adjustments for hospital–acquired conditions. Empirical
evidence shows that payment structures such as these can improve care delivery, costs, and quality
(A Report from Senator Sheldon Whitehouse for the U.S. Senate Committee on Health, Education,
Labor &

Healthcare Policy : The Medicare Savings Program
Please read and review the outside and background sources/readings listed in your Syllabus. Please
select one healthcare issue (policy/position/topic) that is of interest to you and discuss how it should
be addressed politically and as a healthcare policy. Be sure to include the economic impact of such.
Support your position with outside sources. The topic that concerns author Ms. New is the Medicare
Savings Program. The Medicare Savings Program covers part A and part B premiums, deductibles,
coinsurance, and copayments. There are four kinds of Medicare Savings Programs "Qualified
Medicare Beneficiary (QMB), Program expands icon Specified Low–Income Medicare Beneficiary
(SLMB), and Program expands icon Qualifying Individual (QI) Program, and expand icon Qualified
Disabled and Working Individuals (QDWI) Program" (Medicare.gov). If a beneficiary qualifies for
one of these programs they also qualify for extra prescription drug coverage. Today, Ms. New
helped her older friend problem solve her Medicare and Medicaid coverage. In June 2016
unbeknownst to Ms. News's older friend, her plan terminated from the Specified Low–Income
Medicare Beneficiary program (SLMB). The SLMB is one of the programs offered under the
Medicare Savings Program (MSP). The income limit for the SLMB program is $1208.00 a month.
Ms. News's friends' income exceeded the income limit in June. Therefore she termed from the
(SLMB) program.

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