The Affordable Care Act - Strengthening Medicare

txwildflower57 · Sep 11, 2012

Well, you must not be working in Long Term Care because it's biting us in the butt! Our patients benefits are being cut so bad we can barely do therapy or any other types of care that can improve their lives.

VickyRN, MSN, DNP, RN · Sep 11, 2012

Once Medicare has been cut to the bone by the 'Affordable Care Act,' good luck finding doctors who are willing to take Medicare patients. Some small hospitals have already declared bankruptcy due to the draconian Medicare reimbursements requirements and resultant cuts in reimbursements. One is a critical access hospital in my community.

janisleigh · Sep 12, 2012

There certainly have been cuts to medicare benefits, but not from the affordable care act. The significant changes to medicare from the affordable care act have not yet been enacated (begin in 2013) with the exception of some pharmacy benefits for patients and guaranteed annual wellness visits. But cuts in medicare benefits have been occurring for years since managed care (privitization) was started. Additionally, Both Romney and Ryan support cutting over 700 billion dollars from the Medicare budget, but offer no alternatives or solutions as does the affordable care act.

Consider reviewing non-partisan healthcare research sites such as the Kaiser foundation, and Rober-Wood-Johnson fundation for data and statisitics.

Long Term Care Columnist / Guide · Sep 12, 2012

Once Medicare has been cut to the bone by the 'Affordable Care Act,' good luck finding doctors who are willing to take Medicare patients. Some small hospitals have already declared bankruptcy due to the draconian Medicare reimbursements requirements and resultant cuts in reimbursements. One is a critical access hospital in my community.

We're struggling mightily in the LTC world as well, and it's not going to get better anytime soon. Nurses are getting laid off in both hospitals and ECFs, forcing the few who are left to care for more patients with fewer staff and resources. Even within my own company, which is growing and adding personnel, they told us a year ago that we would get an LPN to help me manage my workload if our census went over 75. They said they would do this because our building, filled to capacity, would be too many residents for one nurse. Guess what? We're nearing 90 and can hold 100, and there isn't even any talk of bringing in another licensed nurse, because the company is waiting to see if the roof falls in when all of the ACA's provisions start kicking in come 2014.

Sorry, but I just can't choke down the Obamacare Kool-Aid, no matter how it's served up. It's tough out here in the trenches and it's only going to get tougher; in the meantime, I'm getting no younger and if I can't manage the lives and health needs of 100 frail elderly people, they'll find someone who can. :dead:

Home Health Columnist / Guide · Sep 12, 2012

Not all Medicare changes are result of Affordable Care Act. Some are cost cutting measures recommended by congress to help balance the budget. Critical access hospitals are facing the same pressures my inner city health system is facing:

A.) Less paying customers.

With insurance rates going up, Employers switched to insurances plans with "Flexible spending accounts" monies employees could use for health benefits only for employees to realize their deductibles and copay is $5,000 --- not many can afford that out of their savings, so held off on elective surgeries.

COBRA benefits cost for laid off employees is out of reach for majority.

75% admissions coming thru ER -- no planned admissions for surgery so can fill up beds and even out census.

Increase in for-profit surgicenters, often physician owned, that siphon paying services from hospital coffers.

Federal government's requirement to provide "stabilization" care to any patient showing up in ER.

B.) Lack of Family and internal medicine physicians that care for inpatient--thus need to hire hospitalists. Add to that dearth of ortho and specialists on staff= less to refer to hospital services.

C.) Managed care contracts demanding pay rates less than Medicare --fearful of being cut out of market and patients, many capitated and agreed.

D.) Shift from pay-per proecdre/test to paying for OUTCOMES of care and quality care.

E.) Refusal to pay for NEVER EVENTS -thus hospital absorbing costs.

F.) Overall economic forces: EVERYTHING costs more each year from toilet paper, to food, medications to electricity to run a building. What CAN hospitals control--staffing budget.

These are the provisions of Affordable Care Act that are affecting Medicare

The Affordable Care Act: New Tools to Fight Fraud, Strengthen ..

How the Affordable Care Act of 2010 Helps low income families- The Commonwealth Fund

Medicare cost cutting measures started before Obama elected.

2002 Pay for Performance/Quality indicators : Quality Initiatives - General Information | Centers for Medicare ...

Started 2007: Most doctors headed for penalty over Medicare quality reporting

Growing numbers of physicians are earning reporting bonuses, but hundreds of thousands still have not participated in a program that turns punitive in 2013.

A recent trends report from the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures in 2010. More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria. More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum.

2008: Quality Measurement, Greater coordination and intergration of care

Feb 2009: American Recovery and Reinvestment Act of 2009 put in $$$ for implimenting Electonic Medical Records (EMR) via HITECH Act

About the HITECH Act of 2009 - Understand the HITECH Act ...

I have a few physicians that refuse to have fax machines in their office "they just generate more paper" and many without computer systems. Try getting their attention for critical lab results and getting homecare orders signed after mailed 2x's and not returned requires in-person visit ---waste of staff time and talent.

tyvin, BSN, RN · Sep 12, 2012

Medicare cost cutting measures were implemented before Obama came and now let's start with the $500,000 million that will/has been taken from Medicare to help pay for part of the ACA. Also the link that was provided to inform us that fraud abuse fines and prison time will go up...scary. How many millions did that take?

I think the dems got exactly what they wanted...a new tax that hits every American over the age of 18. I can't choke nor stomach the (insert pejorative) kool-aid coming from the Obama camp. I cringe thinking how the already stressed Skilled Nursing Places will fair. I want to see patient/nurse ratio for those places. The ACA has everything in it yes...bets that they say "nothing" except more rules for the nurses to follow presenting it self in the form of allowed minutes for nursing intervention for blah, blah.

Time for bed...later :sleep:

malamud69, BSN, RN · Sep 12, 2012

Seems to be that ratios etc...have been "terrible" for a long while(in most all business models...that's what you get when you worship capitalism over human dignity!)...before the ACA. I have many family members who have worked in health care for over 30 years and "big business" intrusion is nothing new. Yes the ACA panders in many ways to insurance companies...lets face it...they still own this country in terms of our health care...money talks way more than the sick or the overworked! Don't blame the ACA or Obama..they are tiny pawns in a capitalist horror that treats human beings like dollar signs...if you wake up you will see... So much of it seems to be directly related to becoming more efficient...what's wrong with that as a cost saving measure? Is that not what all these "business" types(and all of you I keep hearing b****ing) about? Even as a newbie to all of this, in my short time I have seen so much laziness and uncoordinated care and complaining from every aspect of health care...these people would not last one day on a construction site! Stop complaining and do something.

Home Health Columnist / Guide · Sep 12, 2012

As Central Intake Manager in a home care agency for 10 years, I affect the lives of over 27,000 persons/year and have responsibility for determining primary insurance payer for home care; maintaining database of local and national insurance payers and negotiating with non contacted payers; thus I have keen insight into healthcare insurnace plans.

Medicare Advantage plans (formerly known as MC HMO's) began ~2006. They were started to allow Seniors/disabled to have a Primary doctor to coordinate care,improve level of care and help control run away costs. Seniors were often automatically enrolled in these plans by state governments and salesman at senior center gatherings if they were dual eligible:Medicare and Medicaid without understanding plans:

a. Patients could only see physicians listed on the payers physician/provider roster: thus if already seeing a specialist/serviced by hospital not yet enrolled in new plan, would be stuck with bill for services.

b. Gatekeeper needed to generate/authorize "Referrals" for service. Practices varied in speediness. Some outright denied legitimate specialist referrals.

c. Biggest secret: Medicare Advantage HMO members if they get sick while vacationing/visiting outside insurance plans geographic area, yet still inside US, have no coverage. So They get billed for care that formerly would have been paid under Medicare nationally AND payers generally write off thousands as uncompensated care due to patients inability to pay for care ---if they had traditional Medicare, costs would be covered.

Seniors on limited income became enraged that doctors actively covering them for care could no longer see them. Coordination of care for certain disease: Cancer TX, dialysis was added under preexisting plan for at least next 6 months followup.

Still there were "Freedom of choice" concerns and need for portable national coverage, so ~ 2008 Medicare Advantage Private Fee for Service and PPO Plans started with Quality goals built in. Insurers were paid TEN PERCENT MORE than Medicare costs. Who made monies on this move: insurance companies stockholders and more importantly, CEO's with exorbitant salaries.

Thus ACA addresses gouging by insurance companies: cut 10% bonus payment and tied-in that 85% insurance plans costs be provided to members benefits; 15% to running plan/profits.

This is a win in my book yet controlling costs at same time.

alwayslookingnp · Sep 12, 2012

Thank you for pointing this out. I am hoping for the best in all this. In my area although more services to more people is the expected the reality is that family practice providers are no longer accepting patients on medicare. This is making it harder for an already vulnerable population to seek and get care.

We still are having "turf war" issues in Texas unfortunately. Anyone falmiliar with the Institute of Medicine (IOM) recommendations on the Future of Nursing and the subsequent recommendations from the Robert Woods Johnson Foundation calling for "Nuring to practice to the full extent of their liscensure." Medicine has said what is really needed is more physicians and many say nurses are not competent to practice evidence based medicine while they refuse to allow new patients into their practice if their payors are medicaid or medicare.

Another sad fact is that after the IOM report was released on Oct 5, 2010, the AMA had a response on Oct 6,2010. Sadly most nurses that I mention the IOM or the RWJ don't know what I'm talking about much less what these reports contain and how they can affect their practice.

Why don't nurses have a voice? This responsibility for this, I believe lies largely with nurses. Do they understand the difference between evidence based practice and doing things because they were taught that way?

Are nurses involved in politics? Why or why not? Is it because they want to clock in and go home or is it because they don't think they have a voice or is it for some other reason. Why don't they have a voice? Among the professional organizations that have legislative influence- there are so many- TNA, ANA, ENA- do most nurses belong to one or more? Why or why not?

At the last legislative session in Texas, the AMA had hours of testimony from 6 organizations about why the IOM and RJF is wrong. Nursing had 2 witnesses. Sigh...

What is a nurse? RN, RNC, CEN, CRNA, FNP, GNP, ANP, CNA (certified nurse administrator or certified nurse assistant?!) It is no wonder the public is confused. We can't even agree.

Lastly, well maybe not lastly but what about our public image? When you see cartoons that protray nurses as fat, stupid, sexy or otherwise incompetent do you laugh? Are you guilty of telling these "jokes" yourself?

Thank you for bringing this subject up. I believe it is more important now than ever. i have been searching Allnurses for months for some recent relevant thoughts on this. Allnurses is a pretty good way to keep up with current issues in nursing and it has been pretty quiet on this issue. Please post your thoughts. I am relly interested in what others think and how it is affecting them in their areas.

wooh, BSN, RN · Sep 13, 2012

I remember back in 2004 when Obamacare caused our ratios to go up. And a bunch of doctors stopped admitting to the hospital because of Obamacare in 2005!

That Guy, BSN, RN, EMT-B · Sep 13, 2012

Maybe I dont get it. More people in the system + less $$ coming in + "free" services = money saved?