Health Care Reforms are divided into two nations: the
nation of Insurance companies and government payers vs. the nation of the
Health Care Provider industry
As reforms relate to the insurance industry, we can
honestly say, “I will never be without health insurance, again!”
For example,
Being denied insurance for a pre-existing condition is gone with the
wind. Health insurance companies won’t be allowed to deny coverage to Americans
in frail health.
Insurance companies that drop you when you get sick are gone with the
wind. As a result of health care reform, health insurance companies will not be
allowed to end your coverage once you are sick.
By 2014 your child’s policy that may exclude coverage for certain
illnesses will be gone with the wind. Insurance companies won’t be permitted to
write child health policies that exclude coverage for certain illnesses.
While the Insurance company reforms serve to guarantee human rights, it
remains to be seen if the reforms of the health care industry will do the same
or if it will be like the burning of Atlanta.
ICD9 codes are soon
to be gone with the wind and ICD10 codes will replace them. For the last few
years, the single biggest issue facing the health care payer industry has been
to figure out how to assess the impact of ICD10 on their technical systems,
processes, payouts, benefit designs, and staff.
Health care as a craft-based culture (centered around episodic illness
and variation in treatment modalities) is gone with the wind. Health care as an
information-age culture (centered around health maintenance and prevention)
where patient needs and the provision of understandable information are given
top priority is in. Health care is transitioning into a new era of
accountability. This era demands heightened awareness of the measurable quality,
cost, and safety of health care, with value (quality/cost) and safety being the
crux of accountability. Payment for volume is gone with the wind. Payment for value (quality/cost) is in.
“Physicians have been paid on a fee-for-service basis since Hippocrates
made his first house call,” said Michael L. Millenson, president of Health
Quality Advisors LLC. “Value-based purchasing represents a true paradigm shift
to paying for value instead of volume.” Doctors might be
facing payment for performance, and unless we change the cost structure, the
inflation of healthcare dollars will rise.
We will likely see a shift in the winds
or, shall we say, a shift in the way patients are treated with the focus going
forward on a more evidence-based approach to prevention of diseases and other
illnesses.
Once the smoke clears, the future of Health
Care reforms and the new united nation that arises from the reconstruction
period will ultimately, hopefully, be stronger.
During
this period of civil unrest, be sure and keep up to date with the many changes
through Inquisit and our offerings in Health Care online, on-demand education. (We
also recommend our classes on obstetrics so all are up-to-date on birthing
babies).
I welcome your responses, comments and any questions
or requests for additional information because “Frankly my dear, when it comes
to Health Care Reform, we should all give a damn!”
Register with www.inquisit.org and be the first to
correctly guess this movie reference to be rewarded with Inquisit IQCards for
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