In 2010, Congress handed, and President Obama signed, the Inexpensive Care Act (ACA), often known as Obamacare. Whereas the ACA has expanded medical insurance entry for tens of millions, sure insurance policies throughout the regulation have led to severe challenges—particularly for small, unbiased hospitals in rural areas.
One in every of these insurance policies, the Hospital Readmissions Discount Program (HRRP), penalizes hospitals financially if sufferers with situations like coronary heart failure or COPD are readmitted inside 30 days. Though this system goals to enhance care and cut back preventable readmissions, it has positioned smaller hospitals in a decent spot when caring for sufferers with superior, advanced situations that usually require ongoing consideration.
A former hospital employee shared how their boss predicted the affect of the ACA when it was signed into regulation. “Our hospital has been independently run since 1904. I’m happy with our board and president for conserving us afloat all these years,” he stated. “However with the brand new coverage denying reimbursement for COPD and coronary heart failure sufferers readmitted inside 30 days, I predict that inside 5 years, our hospital will likely be compelled to merge with a bigger facility.”
He was proper. By 2015, that hospital, like many others throughout the nation, had merged with a bigger community—a pattern accelerated by an ACA provision that streamlines hospital mergers. Meant to scale back prices and broaden entry, these mergers have introduced unintended penalties for rural communities.
Whereas becoming a member of bigger hospital techniques can deliver advantages, equivalent to increased pay and improved assets, it additionally centralizes important providers. Native jobs in billing, scheduling, and administration, which have been as soon as supplied by native residents, at the moment are dealt with in city facilities, lowering rural employment alternatives and lessening the financial affect of those amenities on small cities.
This centralization has additionally made it more durable for sufferers to see medical doctors, as hospital employees at the moment are consolidated in bigger amenities with overcrowded schedules. Many specialised providers, beforehand accessible regionally, have moved to hospitals in massive cities. This requires sufferers to drive longer distances, typically navigating visitors and tough parking.
The HRRP has confronted criticism from healthcare professionals, who argue that the penalties disproportionately affect smaller hospitals. Whereas this system intends to enhance discharge planning and follow-up care, in follow, it typically forces hospitals so as to add pricey administrative employees to satisfy the regulatory calls for with out truly enhancing affected person outcomes.
“Most of the sufferers we see with extreme COPD or coronary heart failure are within the later phases of their illness, so avoiding readmissions isn’t all the time attainable,” one healthcare employee famous. “They’re typically readmitted for issues we will’t management, but Medicare penalizes us even when they arrive again with an unrelated difficulty.”
Healthcare specialists say that these monetary penalties add pressure to smaller hospitals and will in the end cut back the standard of care in rural areas. In some circumstances, hospitals are compelled to merge or cut back native employees to keep away from penalties, leaving rural sufferers with fewer choices for superior care. Many at the moment are required to journey to bigger cities for specialised remedies that have been as soon as accessible regionally.
As these points come to gentle, some advocates are calling for Congress to revisit the ACA and amend insurance policies that encourage hospital mergers. They suggest new laws that would break up massive hospital techniques whereas nonetheless permitting for inter-hospital collaboration to scale back prices and enhance care. Restoring unbiased hospitals might deliver again important native jobs in scheduling, billing, and different areas whereas enhancing healthcare entry for smaller communities.
Advocates argue that sufferers in rural areas would profit tremendously from extra specialists close by, lowering the necessity to journey lengthy distances for routine care. They imagine revisiting the ACA might assist rural sufferers and native economies alike, making a healthcare system that higher serves communities past main cities.
In my humble opinion, many features of Obamacare must be reevaluated, if not utterly revised. With over 20,000 pages, the invoice could must be scrapped and rewritten from the bottom up. Higher but, maybe it is time to contemplate scrapping your entire system and permitting capitalism to work—one thing that has by no means really been tried in healthcare.