Affordable Care Act, Public Legislation, and Professional Self-Regulation: Implications for Public Policy
The need for coordinated, comprehensive, national health care public policy began with passage of the Social Security Act of 1965, which attempted to ensure access to high quality health care for all retired Americans. It also created a system whereby physicians could be reimbursed for care delivered by means of a fee-for-service methodology. However, 20 years later, with unrestrained growth in health care resource utilization due to a dramatic increase in numbers of Medicare beneficiaries, health care strategists began to recognize that health care spending would threaten the entire US economy and the financial solvency of entitlement programs such as Medicare, Medicaid, and Social Security. Government public policy quickly pivoted to cost containment efforts. Through a series of several innovative, groundbreaking demonstration projects linking process to clinical outcomes, the US government began to appreciate the high cost of poor quality health care both in terms of the crushing financial burden and the specter of preventable complications and unnecessarily high mortality rates. The essential core of all health care public policy in the USA for the last decade has been an attempt to engineer a care system that decreases resource utilization while simultaneously maximizing quality of care. Elements of this effort can be seen in legislative achievements such as the Patient Protection and Affordable Care Act (ACA), passed in 2010 and the subsequent Health Care and Education Reconciliation Act Amendment. Today, the Centers for Medicare and Medicaid Services (CMS) is aggressively moving to abandon traditional Fee-For-Service payment methods which are extremely problematic in incentivizing decrease in resource utilization. Instead, Alternative Payment Models (APMs) are being created and tested which attempt to remove variability in care delivery, offer more coordination of care by providers, and drastically reduce costs by reimbursing clinical care entities (e.g., Accountable Care Organizations) one payment for an episode of patient care, regardless of how many providers participate in the care of the patient or costs incurred by the entity in providing the care. It is yet to be determined whether these efforts will be successful or not. Either way, health care in the USA will never be the same.
KeywordsMedicare Costs Quality Fee-for-service Alternative Payment Models (APMs)
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