Health Care Reform: Frankly My Dear, We Should All Give a Damn

For the last 2-3 years, the whole country has been in the grips of the Health Care Reform changes - meaningful use, health benefit exchanges, HIPAA 5010, ICD10, ACA, and Value Based Purchasing.  Still many aspects of the health care industry as we’ve known it are already gone with the wind.

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!” 

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