Introduction
Providing affordable and reliable healthcare is one of the key goals of many nations. In the United States of America, the signing of the Patient Protection and Affordable Care Act, which is simply referred to as the Affordable Care Act (ACA), in 2010 was a crucial step towards the realization of this goal. The main purpose of the ACA was to enhance the quality of health care services and ensure that as many people as possible can have access to these services. Other goals of the ACA included introducing checks and balances to the insurance industry and reducing health care expenditure (French, Homer, Gumus, & Hickling, 2016). Consequently, several provisions were made to facilitate the realization of these objectives. Additionally, healthcare organizations were required to change some of their operations to align with the objectives of the ACA. The introduction of the ACA led to significant changes in the day-to-day operations of the health industry. The purpose of this paper is to address organizational preparation and strategic response to at least three provisions of the ACA.
Prevention of Hospital Acquired Infections
Section 3008 “Payment adjustment for conditions acquired in hospitals” under part 1 “Linking payment to quality outcomes under the Medicare Program” of Title III “Improving the quality and efficiency of health care” seeks to reduce payments to hospitals that report a high incidence of hospital-acquired infections (HAIs) (Office of the Legislative Council, 2010). Pay for performance was announced to motivate hospitals to invest in quality projects to enhance patient outcomes. The Medicare prevention of hospital-acquired infections program under the ACA has set up hospital payment for performance based on scores that consider the incidence of HAIs. Hospitals that record the lowest performance (the bottom quartile) have their revenues from Medicare reduced by 1%. Thus, the burden of costs implicated in quality improvement is borne mainly by health care providers, even though payers and patients also suffer the consequences. The purpose of the financial penalties is to enhance the quality of health care services by urging hospitals to factor the fiscal repercussions of poor quality in their investment decisions. The rationale of this provision was that if payers reimburse providers for the extra treatment costs that accrue from poor quality services, then there would be no motivation to enhance the quality of services.
Organizational Preparation
One of the major aspects of organizational preparation with respect to this provision is a focus on evidence-based research to find and implement recommendations to prevent hospital-acquired infections. It was noted that educating staff members and patients about hand hygiene were the first crucial step because most HAIs were a result of the transfer of infectious microbes from one person to another. Therefore, there was a need to invest in more comprehensive infection prevention programs and educate healthcare workers regarding the microbiologic facets of infectious bacteria, risk factors, identification, treatment, and prevention. Peer-to-peer learning also facilitated the exchange of information among health care workers.
Strategic Response
Following the intensive review of evidence-based recommendations to reduce HAIs, specific strategies have been identified. They include infection control practices such as using protective barriers like gloves, face masks, gowns, face shields, and protective eyewear to minimize the work-related spread of microbes from the health care worker to the patient and vice versa. Protective gear such as gloves should be changed each time a medical provider attends to a different patient. These precautions are to be taken, notwithstanding the infection status of a patient. Other strategies include identifying patients who are at a high of developing nosocomial infections, proper hand hygiene, and adhering to set standards meant to reduce HAIs such as catheter-associated urinary tract infections, catheter-associated bloodstream infections, and ventilator-associated pneumonia. Additional strategies that have been used in this regard include pinpointing the likely source of infectious microorganisms in specific situations, isolating affected patients, the selective use of prophylactic antibiotics if required, and surveillance.
Technological advances should also be embraced to reduce HAIs, for example, applying movable machines that use ultraviolet light to kill pathogenic bacteria and viruses. These machines supplement regular cleaning to guarantee sterility. It has been reported that the use of these machines has lowered the incidence of Clostridium difficult and Staphylococcus aureus significantly (Anderson et al., 2018). Furthermore, biosensors that combine bacteriophages and certain antibiotics have made it possible to identify antibiotic resistance in bacteria, thus enabling clinicians to use the most appropriate antibiotics for various conditions. Computer simulations that make use of real-time data from electronic emergency departments have been used to identify potentially communicable illnesses and predict their occurrence.
Hospital Readmissions Reduction Program
Section 3025 “Hospital readmissions reduction program” under part 3 “encouraging the development of new patient care models” of Title III “improving the quality and efficiency of health care” requires the Centers for Medicare and Medicaid (CMS) to cut down payments to inpatient prospective payment system (IPPS) hospitals with high rates of readmissions (Office of the Legislative Council, 2010). This move was informed by 2011 statistics indicating that 3.3 million patients had been readmitted to hospitals, thereby leading to the expenditure of $41.3 billion (Office of the Legislative Council, 2010). The Medicare Hospital Readmissions Reduction Program (HRRP) punishes acute-care hospitals that record-high rates of 30-day readmissions with respect to six major conditions: heart failure, heart attack, pneumonia, coronary artery bypass graft, chronic obstructive pulmonary disease (COPD), as well as elective hip and knee replacement. Affected hospitals were to receive a 1% deduction of their total Medicare reimbursements from 2012, which would increase to 2% in 2013 and 3% in 2014.
Organizational Preparation
The first step in addressing this provision is identifying patient populations at high risk of hospital readmission to facilitate targeted interventions. Uninsured patients and covered by Medicaid were more likely to be readmitted to the hospital due to preventable diseases compared to those with private insurance, particularly among maternal patients (Soley-Bori et al., 2015). In contrast, uninsured patients were less likely to be readmitted to hospitals than Medicaid patients. Patients with limited English proficiency are more likely to be readmitted than those who understand English (Seman et al., 2017). Therefore, healthcare organizations were compelled to invest in recruiting and training interpreters to circumvent such language barriers. Furthermore, sign language interpreters were also recruited to facilitate communication between health care providers and patients with hearing impairments.
Part of the organizational preparation to reduce hospital readmissions included implementing evidence-based strategies of maintaining patient wellbeing following discharge. It has been shown that adequate staffing of nurses can minimize preventable readmissions and emergency department visits. This observation was attributed to improved quality of discharge teaching as well as adequate preparation of patients for discharge. Adequate staffing allows nurses ample time to prepare patients for life outside the hospital.
Strategic Response
Reducing hospital readmissions involves many calculated moves, such as participation in incentive programs with health insurance firms that strive to minimize the problem. An example is a hospital-physician inducement program through a pay-for-performance model that urges several health care institutions to work together to cut down HAIs and readmissions. The key strategy used here is adhering to evidence-based recommendations for the treatment of surgical sites, pneumonia, heart attack, and heart failure.
A second strategy is making sure that patients book a follow-up after seven days of hospital discharge. This approach is supported by evidence showing that patients who received follow-up advice from their physicians within the first seven days of discharge had lower chances of being readmitted to the hospital (Jackson, Shahsahebi, Wedlake, & DuBard, 2015). Providing post-discharge care is an effective approach to cutting down readmissions. Healthcare organizations can enlist the help of home health aides or medical social services. A pilot study involving the use of home health care for patients with chronic illnesses resulted in better outcomes regarding hospital readmission rates than long-standing acute care hospital services.
Additional strategies being employed include providing transitional care to patients to ensure a seamless changeover from hospital to home care. Nurses play a vital role in this process, as shown by the findings of a systematic review highlighting the importance of nursing care in hospital transition (Jones et al., 2016). Consequently, many hospitals are entrusting nurses with leadership responsibilities, for example, clinical management or checking up on discharged patients at their homes. The value of patient education and effective communication cannot be undermined in preventing readmissions. Clear communication of post-discharge instructions ensures that patients adhere to instructions to maintain their health status while at home, thus eliminating the need to return to the hospital for specialized care. The teach-back method, where patients are asked to reiterate the instructions given to them to confirm their comprehension, is commonly used. Technology has also been used to keep an eye on chronically ill patients. For instance, telemonitoring devices have been helpful in keeping track of the progress of congestive heart failure patients following discharge.
Increasing Access to Clinical Preventive Services
This provision is found in Subtitle B under Title IV of the ACA. It stipulates that all new plans need to cover various preventive health services for various health complications without levying co-pay, deductibles, or coinsurance (Office of the Legislative Council, 2010). The role of preventive services is to enable the prompt detection of health problems that can be managed easily through timely treatment and empower the masses to make sound decisions regarding their health. Examples of health services covered are immunizations, screening tests, and counseling. Specific screenings encompass gestational diabetes, HIV, domestic violence, human papillomavirus, contraceptive counseling, breastfeeding support, and contraceptive counseling for women (Fox & Shaw, 2015).
Organizational Preparation
The ACA selected a number of organizations as sources of reliable guidelines that identify specific clinical preventive services and age groups of people who should receive them without deductibles or copays. Such organizations include the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP). These entities consist of health experts who generate evidence-based guidelines for clinical services to preclude and control diseases. The Health Resources and Services Administration (HRSA), on the other hand, supports the recommendations suggested by the American Academy of Pediatrics Bright Futures program for children. Endorsed services for women are founded on the Institute of Medicine’s (2011) report titled Clinical Preventive Services for Women. ACA acknowledges services endorsed by these organizations. The statute also compels the adoption of new clinical recommendations from these organizations by non-grandfathered private plans at least a year following the issuance of the recommendation (Fox & Shaw, 2015).
Strategic Response
One challenge that remains despite the ACA’s recommendations is the adoption and use of preventive health services. Therefore, various organizations have conducted detailed studies to identify gaps and enhance the adoption of preventive services. For example, the Centers for Disease Control and Prevention (CDCD), in partnership with CMS and Agency for Healthcare Research and Quality (AHRQ), published an article “Enhancing the use of clinical preventive services among older adults: closing the gap” (CDC, 2011). The report accentuates critical inadequacies by revealing the number of adults above the age of 65 who do not receive the endorsed services. These findings emphasize the need to join clinical and community approaches that concentrate on underserved populations. Even though preventive services are conventionally offered in clinical settings, it is possible to deliver them within schools, worksites, homes, or residential treatment centers within the community. Therefore, community-based preclusion, policies, and programs are currently used to back clinical preventive services.
Conclusion
The ACA symbolizes the most important statutory change made in the US health care system for a long time. Many of the reforms proposed in the act have already led to significant changes in the organization and delivery of health care services. However, these changes have been made possible through organizational preparation and strategic responses. These observations show that any substantial change in the health care system requires deliberate planning and strategic execution.
References
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