Health Care Essay Cost, Access and Quality PDF

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1 Amy Olsen HLT 205 June 8, 2019 Maria Nunes Health Care Essay: Cost, Access, and Quality In today’s world all Americans want the very best quality healthcare at their disposal and at the very least amount of money. However, nobody thinks about what the bottom line is, or who is the one pay for it. People want it and they want it now. Physicians are being held to higher accountability on what test they are ordering and why they are ordering it, because of the alarming rise each year in health care costs. Physicians must provide quality health care to all patients who have high expectations, with restrictive guidelines while they have a plethora of resources that they may or may not be able to use due to cost. Americans have high expectations of finding cures through science and technology, and they connect the use of such advanced medical technology with high-quality medical care (Shi, Singh, 2017). People believe that the quality of care means you get the newest drugs, the most advanced procedure and the highest tech imaging, when in reality this is not always true. What Americans don’t understand is that most of these things come with a high price tag. Quality is enhanced only when new procedures can prevent or delay the onset of a serious disease, provide a better diagnosis, make quicker and more complete cure possible, increase the safety of medical treatment, minimize undesirable side effects, promote faster recovery from surgery, increase life expectancy, and add quality of life (Shi, Singh, 2017). The cost of health care has drastically increased over the years. In 1970, the government had grown by 140% from $7.9 billion to $18.9 billion. During the 1980 the rate of increase

2 started to slow down and by the 1990s it was at a rate of 5.7 % (Shi, Singh, 2017). So what is making the cost of health care rise: third-party payments, growth in technology, increase in elderly population, medical model of health care, multi payer system and administrative costs, defensive medicine, waste and abuse and practice variations. Third party payer means, neither the patient nor the provider is paying the bill, the insurance is, so there is no incentive to be aware of cost. Technology is always growing and changing, and that is not inexpensive. The “baby boomers” are becoming Medicare eligible which is costing more money the government. Medical model health care describes the care for a person once they are sick, not preventative health measures. Multi payer system is an administration charge related to insurance. Defensive medicine either avoiding high risk patients or prescribing unnecessary treatments or test. All of these things are contributing to the rise in health care. The medical community originally formed Physician Quality Reporting System (PQRS). Physician Quality Reporting System reporting quality data from EMR to Medicare. It was initially a positive program to collect data however, PQRS use negative payment adjustments to motivate physicians, influence their behavior, and hold them accountable to provide high-quality, cost-efficient care, and report on that care (Shi, Singh, 2017). The ACA requires that the U.S. Department of Health and Human Services develop a quality data collection tool similar to the PQRS system, a quality improvement strategy, and a enrollee satisfaction survey system. The information gathered will inform consumers of a Quality Health Plan (QHP) (Shi, Singh, 2017). These monitoring strategies will ensure insurance, facilities, and physicians are forever being held to the highest standards. With the ever-changing cost of health care and challenges of billing and repayment, physicians are challenged with the thought of even accepting patients with Medicare or Medicaid. The Center for Medicare & Medicaid Services is launching two new programs in 2019 to help clear the

3 uncertainty of repayment. The first new option is called, Primary Care Frist model. It is directed at primary care practices. Practices will receive a flat payment per beneficiary which will allow the clinician to focus more on the care of the patient instead of the revenue. The practice will be able to receive a 50% bonus, or 10 % penalty based on performance as an incentive to reduce cost and improve quality(Twatchman, 2019). The second option is, Direct Contracting model. This is aimed at more ambitious and larger practices with > 5,000 patients. Options under the direct contracting model are designed for the organizations ready to take on full financial risk that have experience managing large populations with accountable care organizations or working with Advantage plans. The Direct Contracting Plan model will start with two options Professional population-based payment (PBP) this offers a lower risk-sharing arrangement 50% savings/loss, while Global PBP offers a 100% savings/loss sharing arrangement (Twatchman, 2019). Without either of these payment options more and more physicians are rejecting new Medicare and Medicaid patients. In 2011, 31 % of physicians did not accept new Medicaid patients and 17 % of them would not accept Medicare patients (Decker, 2012). As an overall score America had some highlights in some spots in quality of care. For example, 50 percent of adults with high blood pressure had it under control in 2007-2008, compared to only 31 percent in 1999-2000 (Health Insurance, 2011). Gradually there is an improvement on incentive to stay healthy, instead of damage control. America is making big changes to the way they are keeping monitoring and keeping facilities, physicians and insurance companies accountable for their spending. In the long run it will all pay off. Physicians are accepting new Medicare and Medicaid patients again. Physicians are practicing quality medicine, providing quality care while using adequate testing. Insurance companies, physicians and patients are all coming to an agreement. However, I do not see that

4 there is a universal health care system in Americas near future, America is not prepared to fund a big over haul tax like. Quality health care is forever a concern. However, it seems to be well addressed and is a top priority for many top officials.

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References Decker, S.L (2011). Nearly One Third of Physicians Said They Would Not Accept New Medicaid Patient, But Rising Fees May Help: In Health Affairs Retrieved from http://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.0294?sid=4fb2fe2e-c9fb 4e87-b58d-9bbb8a4e1746& Health Insurance, (2011). Common Wealth Fund Commission National Health Care Scorecard: US Scores 64 out of 100. Surgery Litigation & Law Weekly Retrieved from http://lopes.ldm.oclc.org/login?url=http://search=progquest- com.lopes.idm.oclc.org /docview/90065514?acotid=7374 Shi, L & Singh, D. (2017). Essentials of the U.S. Health Care System Fourth ed., pp 23-102. Burlington, MA: Jones & Bartlett Learning Twachtman, G. (2019, May). MEDICARE CMS pushing primary care with two payment models. Internal Medicine News, 52(5), 31....