Federal Regulations and Their Effect on Healthcare Organizations
Regulations play an exceedingly crucial role in the delivery and management of healthcare. This regulations control the entire health care industry as well as health care insurance coverage. Both federal, state and local regulatory bodies provide numerous public health and welfare policies and programs protecting the public from varying health risks and exploitation. Healthcare standards and regulations are necessary in ensuring the provision of safe health care and compliance from all stakeholders facilitating the delivery of quality services to all people accessing these systems. This paper identifies and reviews three different federal regulations that have impacted the financial management of healthcare systems in the United States.
The Affordable Care Act (ACA) (2010)
Also Known as, the Patient Protection and Affordable Care Act or Obama care, the ACA was passed by United States 111th congress and on March 2010 into was signed into law by the then president Barack Obama (Healthcare.gov, 2018). The legislation was adopted to change the way American people are insured. The goals of the act included the lowering of healthcare costs and the availability of cover for all uninsured individuals. It was also aimed at lowering federal government expenditure on healthcare. This health reform legislation has seen tremendous support by availing medical insurance to between 32-52 million Americans (Healthcare.gov, 2018). Additionally, it has enhanced the affordability aspects of healthcare and improved healthcare systems efficiency by eliminating varying industry practices such as denial of coverage because of preexisting conditions and rescission.
Health Insurance Portability and Accountability Act (HIPAA). Passed in 1996.
President Bill Clinton passed this Act into law in August 1996 (Journal of AHIMA, 2013). The Act was necessitated by the need to address the security and privacy of people’s health information. However, the HIPAA ushered a new era in the management of healthcare transforming the way information was acquired, managed and utilized to deliver quality care. Even though the law took about 7 years to take effect, it has seen immense progress ensuring effective management of patient information and healthcare systems (Journal of AHIMA, 2013). The law has allowed for enhanced security measures, increased risk assessments, compliance, oversight and visibility. The Act enables people to continue receiving health insurance coverage even after job changes or job loss. However, its focus is on the adoption of electronic healthcare allowing for appropriate identification of providers and health insurance plans.
Medicare Access and CHIP Reauthorization Act (MACRA). Passed in 2015
This bipartisan legislation was passed by congress in April 2015. The main aim of the legislation was to replace the Sustainable Growth Rate formula by establishing two different methodologies of paying physicians that include the Advanced Alternative Payment Models and the Merit Based Incentive Payment System (NRHI, 2018). The intentions were to ensure that physicians were paid fairly, healthcare was improved and Medicare Part B costs were controlled (NRHI, 2018). Additionally, it would combine the existing quality reporting systems into one unique system. The legislations is enabling the government to offer its citizens value based healthcare. The rollout of MACRA is linking physicians’ payments to service value changing the traditional model where payment was linked to service volume.
In conclusion, all this initiatives and legislations were passed to change the traditional business models used in the United States healthcare industry. The legislations have been evolving gradually seeking to ensure affordability and value based healthcare. They focus on regulating the practices of healthcare providers and insurance covers. Their implementation is continuous and evolves with time for the betterment of healthcare provision.