Will Medicaid and Medicare Reforms See Rise in Healthcare Standards by 2015?

With more than 90 million Americans covered under Medicare and Medicaid insurance services, the U.S. healthcare system is heavily dependent on the success of healthcare reforms to improve care standards. All healthcare reforms are currently focusing on two parameters of care – cost and quality. Every new rule and guideline which is being introduced is either resulting in reduced healthcare costs or setting benchmarks for primary care. The objective of providing affordable care to each and every American by the next 20 years is the foundation of Medicaid and Medicare informs, thereby underlining the importance of healthcare standards. Some major Medicare and Medicaid reforms which are likely to improve care quality are –

• Subsidies for prescription drugs – Medicare and Medicaid offer payment subsidies to covered individuals on purchase of premium as well as regular prescription drugs. This not only decreases the care cost of medical institutions but prove highly beneficial for patients as well. Controlled costing of prescription drugs offer a blanket of medical care coverage to different segments of patients. Although there are terms and conditions applied for those above the income bracket of $85000 (per person annual salary), the overall effect on healthcare standard is beneficial.

• Similar charges for Home care and medical institution care – Medicare has also introduced parity in reimbursement rates for medical attention given outside medical institutions and within these institutions. This has dramatically reduced the pressure on patients seeking primary care to get admitted in hospitals for availing insurance benefits. It is not only likely to improve care quality and patient satisfaction but also expected to reduce administrative costs of care providers.

• Broader Medicaid enrolment – Traditionally Medicaid only allowed enrolment of children or adults with children. But with new healthcare reforms, any adult below the age of 65 will be eligible for Medicaid enrolment. This would entail greater medical coverage for adults without children and even pregnant women. Personal medical care costs are likely to drop dramatically with this change. Not only that, care providers would also be able to achieve a better rate of reimbursement and claim settlement with this reform.

• EMR stimulus and penalties – The U.S. government is offering EMR stimulus for those practitioners who have meaningfully adopted EMR for their coding, billing and documentation procedures. Medicare reimbursements will also shrink by 1% in 2015 for those medical practitioners who will fail to adopt EMR successfully. This measure has been adopted to encourage digitalization of medical data and procedures. Patient medical records when maintained properly can lead to accurate insurance claim settlements and avoid any inconvenience for both care providers and patient. The EMR drive is thus likely to improve the overall productivity of healthcare industry.

• Fee-for-service models – The gradual but certain shift towards fee-for-service or pay-for-performance model of healthcare services is bound to heighten patient satisfaction and reduce customer complaints. Medicare and Medicaid reforms are ensuring adoption of this payment model by all care providers in order to generate greater sense of responsibility amongst medical practitioners towards their patients.

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Published By - Medical Billers and Coders
Published Date - Oct-25-2013 Back