Now in control of all three branches of the Federal government, the GOP has made it clear its agenda over at least the next two years will focus tightly on deregulation – including with a priority push to effectively defund the Affordable Care Act (ACA). In this guest post, Shawn Yates, director of healthcare product management at an ARM and RCM solution provider, will detail the major developments that will come about because of it.
With the new regime in place, healthcare revenue executives will find themselves with a new set of challenges to meet, as out-of-pocket amounts for seniors rise, and tighter restrictions on Medicaid qualification move millions of Americans back to being uninsured. These truths will obviously have a big impact on healthcare reimbursement over the next two years.
But what will the most major developments include?
- The uninsured will grow – Moving Medicaid to block grants, whereby the federal government would give fixed amounts to each state – who would then determine how to use the funds themselves – will reduce the available funds for this demographic, causing tighter standards for qualifications, and moving many to become uninsured. Combined with changes in the ACA, this activity will create a situation where a movement back to a larger uninsured demographic will transpire, effectively moving the industry back to the pre-ACA days.
- Post-discharge financial assistance screening will become even more important – Higher numbers of uninsured patients and strict guidelines for enrollment will result in many more patients struggling to pay for the cost of their own care. Providers will revamp their financial assistance programs to handle many more patients and use automated technology/workflow to assist in this process.
- Providers will have an even tougher time managing a positive margin – Reimbursement cuts were made to help pay for the ACA’s programs when the law was created with the logic that they would help more people become insured, and in turn benefit providers. But it’s unlikely that these reimbursement cuts will be rolled back, due to current federal budget deficit issues. Providers will have to do more with less. Coupled with a growth in uninsured patients who will require more assistance to qualify for Medicaid, we can see a major challenge to maintaining a positive margin on the horizon. Providers will need to find solutions that increase productivity.
- Value-based purchasing and bundled payments may change – Campaign rhetoric over the last year has dictated unnecessary regulation will be laid waste. And with that sentiment, we might see the change, or possibly end, of value-based purchasing and bundled payments. With the GOP discussing how funding will be delivered more directly to people or states and with the assumption they’ll know how to best distribute it among their communities, it seems logical that something similar will happen here. There’s not as much talk about these provisions early on, but value-based purchasing is directly tied to the ACA, so if this law is changed dramatically, we should expect changes.
So what’s the big picture to take from all of these concerns?
Providers’ profit margins will continue to be challenged, forcing them to increase productivity through automation, and eventually increase in cash recoveries. Combining separate patient accounting processes into one integrated system, and one efficient process, will become critical. Providers must continue to provide a single patient experience with many self-serve options tied to patient accounting processes.
Technology improves every day, and will provide solutions to these problems as enhanced automation helps providers focus only on the exceptions instead of every account. Start looking and you will find improvements.
Shawn Yates is director of healthcare product management at Ontario Systems, an ARM and RCM solution provider.