Moving Forward with the Affordable Care Act: Trends in Self-sustained Obstetric Institution
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- Matevosyan, N.R. J Knowl Econ (2016) 7: 488. doi:10.1007/s13132-014-0220-9
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The economic burden of obstetric care is multifold and mordantly case-specific. Obstetrics is a huge cost to the U.S. healthcare system. Maternal-infant care represents the largest single category of hospital expenditures for most commercial health plans and state Medicaid programs. Reducing these costs provides a major opportunity to reduce insurance premiums for employers and to make Medicaid coverage more affordable. The Patient Protection and Affordable Care Act (2012) encourages the State contracts with Accountable Care Organizations (ACO) by transforming traditional fee-for-service contracts into bundled contracts paying providers and facilities in a single fee. It is then the role of the physician, hospital, or institution to develop strategies to cut costs, improve outcomes, collect, tabulate and report results, and to be competitive within the new reality of the ACO. An attempt is made to develop a theoretical model to assist institutions in moving forward with the Affordable Care Act, by introducing strategies for a self-sustaining obstetric ACO in the following clusters: (1) cost containment, (2) combating stereotype, (3) medical recording, and (4) revenue enhancement. We conclude, that trends in relatively low costs care by both providers and patients are potent with hidden or adverse expenses and remedies. Self-sustained ACO in obstetrics are feasible when stemmed of well-developed patient-centered policies and screening protocols that balance the input–output ratio favoring the patient. Marketing and defense tactics are discussed.