Question

In a total of 250-500 words, respond to the questions located in the Primary Care Scenario.

Scenario:

A family practice that serves over 4,500 patients is owned by three brothers, all general practitioner medical doctors who have been closely watching how the new Patient Protection and Affordable Care Act (ACA or “Obamacare”) is developing, especially with the ongoing changes to the eligibilities of coverage for patients and reimbursements that now require their facility to change its systems and processes for compliance.

As a healthcare consultant, you have been retained by the family practice to perform a thorough audit and analysis of the facility, including its systems, processes, and procedures, with an emphasis on record keeping and coding/billing practices.

You have also spent some time with the owners of the family practice discussing what the future holds regarding the types of treatments, demographics of patients, and the effect of technology on the methodologies of patient treatment. Within this context, the client asks you to provide the following:

Questions:

When comparing the overall health care system in America, how does it compare to just 40

years ago?

Provide some examples of what specifically is critical for the healthcare organization to consider regarding how treatments are performed on patients.

What technological advancements do you predict in health care in the next 15 years, especially those that can be opportunities for a family medical clinic scenario?

What are the regulatory agency changes coming in the near future?

What are your predictions for the success of the ACA, especially in the next 5 years?

Answer 1

Comparison of medical system:

Before 40 years the country did not have a proper insurance system and also the cost of provide treatment for the needy people especially old people. It was in 1971, a single payer plan was proposed the funds for which would come through taxes. This is nothing but the employers offering health plans to its employees. In this case the doctor’s fees would not be influenced by government decisions. There were two tasks that were accomplished during this period namely social security amendment of 1972 and health maintenance organization act of 1973. These two established some order in the healthcare industry and the American medicines were in crisis because of recession and heavy inflation.

The present scenario is the establishment of ACA (Affordable Care act)). Many people applied for insurance through this. The big advantage of this ACA is it covers the pre existing condition clause. It also covers the maternal and prenatal care. Previously this was not available as pregnancy was considered as pre existing condition and the services were denied.

What is critical for the healthcare organizations?

The healthcare organizations face challenges in providing safety treatment to its patients. It is related to the technology used. Previously the institutions were providing treatment manually by giving importance to physical changes such as touch, smell, sight etc. for example through the use of technology, the nurses rely more on data from monitors rather than important changes that take place in the clinical status of the patient. Though advancement of technology is useful for providing advanced treatment to the patients, sometimes it has its own risks.

Technological advancements in healthcare systems:

• New paradigms that can make the healthcare more affordable and more convenient.
• The workforce in the healthcare team would completely change where they may be trained uniquely and have greatest value in the services provided by them.
• Another change can occur relating to the payment systems. The healthcare service providers will no longer be paid for the service provided by them but for keeping the patients healthy.
• Helping the people to manage their risk factors and also managing the sick people by avoiding frequent visits, excessive consumption of medicines etc.

Regulatory agency changes:

Immediate response to patients in order to avoid the delay that they experience while undergoing some tests. A patient usually takes off from his job for undergoing tests prescribed by the physician but the results would take three to five days to be discussed to the patients. This wastes the time of the patients. Hence the medical system should be designed in such a manner that can provide immediate solutions to the patients. The regulation can change since the patients wait so long for their results and want their solutions to be given at the earliest time.

Predictions for ACA.

• The ACA can lower the premium on the insurance charged.

Some regulators argue that if ACA goes for higher rates then it can experience losses and there may be chances of them not continuing in the near future if it is not possible for ACA to have a control over its costs.