Health Care Law Changes Reimbursement Systems Research Paper

Health Care Law Changes Reimbursement Systems - Research Paper Example This study evaluates the benefits and disadvantages of these proposed reforms. On the one hand, the reforms could improve quality of service by providing incentive for hospitals and increasing competition among them but on the other hand, ordinary citizens could also be affected because many expenses that were earlier applied against FSA and HSA accounts may no longer be possible. Medical reimbursement in the United States Introduction: The costs of health care in the United States are prohibitive and only a few people in the country can afford to avail of health care without any form of insurance. Private health insur4ance plans are available in the country and most employees have access to some form of health insurance through group insurance plans that are offered by their employers. Most people in the United States however, fall under the category of Medicare or Medicaid insurance plans to cover their health care costs. Medicaid is available to individuals who are from the poorer socio economic backgrounds and have no insurance at all. Medicare is the public health insurance program which has been formulated to provide for the health care of the elderly and the disabled. It covers individuals who are aged 65 or over, or under 65 but with certain disabilities and those of any age with permanent kidney failure (www.medicare.gov). In the year 2003, Medicare expenses cost the U.S. Government a sum of $271 billion, representing 13% of the federal budget (Frankes and Evans, 2006). The program comprises two parts – Part A which covers hospitalization and nursing facilities, and Part B which covers physician and outpatient services, laboratory charges and medical equipment. Since costs for the Medicare program were turning out to be prohibitive, changes were introduced to the reimbursement policies in 2008, in an effort to reduce some of the expenditures and thereby bring about some trimming of the federal government budget on health care. The sweeping chang es proposed reduced payments for complex medical treatment procedures by 20 to 30%. Some of the major changes which were introduced and came into legal existence in 2008 were as follows (www.seniorjournal.com): (a) reducing reimbursement for procedures such an angioplasties and implanting of drug coated stents by 33% (b) reducing reimbursement for implanting defibrillators by 23% (c) Reducing reimbursements for hip and knee replacements by 10% Reimbursement for other diseases was also cut down; hospitals and health care professionals fully reimbursed only if their patients were suffering from one of 13 diseases which have been listed. The Medicare reimbursement policies for Inpatient Rehabilitation Facilities were revised further in 2009, validated legally from 2010. The patients are classified into different categories based upon their clinical symptoms and payments for clinical conditions that are secondary to the major one are no longer reimbursed (Ingenix, 2009). Cost outliner p ayments have also been readjusted to 3% of total estimated payments for Inpatient rehabilitation facilities. Coverage criteria were further revised for inpatient rehabilitation facilities with several pre-conditions being exposed, such as mandating therapy treatments to begin with 36 hours of the midnight of the day the patient was admitted.(Ingenix, 2009). It may be noted that the changes which had