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Healthcare Trends

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A.) Healthcare Trends

Many trends are emerging in the United States healthcare system which are influenced by government legislation, options for delivery of care, fluctuations in social or economic conditions and even changes in payment methods. It has been noted there is a acute shortage of primary care physicians. According to the Association of American Colleges, there will be a shortage of more than 60,000 doctors by 2015 and will increase to 90,000 by 2020 (Long, 2012). The healthcare system is a unorganized business model and at this time our health care system relies on medical professionalism, the Hippocratic Oath with providers rendering fair open access to health care with unnecessary financial gains.

The multi-tiered delivery system trend of healthcare is pyramid shaped. The pyramid's first tier begins with the top 5% of the population who earn what is considered to be "high income". These people traditionally make use of policies with high deductibles, either through coverage provided by their employer, or individual (non-group), policies. On the second tier of the pyramid are the 38% of the population, which are generally those with full-time employment and partake in an employer sponsored health insurance policy (HMO, PPO), possibly supplementing that policy with private health insurance or Medicare. Making up the base or bottom of the pyramid, is the majority (57%) of the population who are eligible to receive health care from any available resource that is offered. Usually folks in this bracket are unable to afford more than the most basic or preventive care even though they may be eligible, and when seeking assistance find that the low Medicaid payment rates generally restrict the choice of healthcare provider (Hammaker, 2012).

Another healthcare trend that can improve healthcare is cost-based reimbursement and quality incentives that could be offered. A provider could be reimbursed for a full treatment cycle rather than in set amounts the patient is treated. (Hammaker, 2012) One strategy that could be used to lower costs of healthcare and improve quality in the U.S. includes value-based purchasing. Pay-for-performance is a type of value-based purchasing that utilizes an incentive-based reimbursement system to drive positive change in a cost-effective manner. All pharmacy departments and institutions goals should match. (PAP, 2012) The pharmacies will have to carefully evaluate current services and practice models to ensure that they are delivering safe, effective, and efficient care. Data collection and analysis will be critical for both identifying areas for improvement and tracking outcomes. Important steps in successfully meeting pay-for performance demands is having effective communication of performance goals to staff, establishing accountability for front-line staff, and working collaboratively with other disciplines and departments. (PAP, 2012)

One other downward healthcare trend is reimbursements paid by the government to healthcare providers and hospitals. Prior to the adoption of the prospective payment system (PPS) in 1983, Medicare reimbursed all costs incurred by a patient covered under Medicare insurance. (Hammaker, 2012) Prior to the implementation of the PPS, there were few incentives for furnishing care efficiently and result in unpredictable payments. The PPS provides a fixed payment rate for a specific bundle of services for clinically similar patients requiring resources objectively measured. This reduces the incentive to add unnecessary services to a particular period of care. (CMS, 2012) Efficiency is encouraged by allowing providers to keep costs below their payment rate so they can retain the difference. The PPS also increases predictability in health care spending, through recognition of historical base period costs and specified updates applied to those costs to determine the payment rate for each unit of service. (Thompson, 2012)

A1.) Impact

A large impact on the delivery of healthcare services will be the physician shortage. This can dramatically impact the underserved areas. Fewer new medical graduates are not as attracted to serving in these locations. Due to the baby boomers looking to retire in the next 5 to 7 years there is also an increased need for healthcare. In some areas, patients are not receiving preventive care and health maintenance due physician shortages. Of course this all trickles down into the emergency room (ER) visits will definitely increase. Patient needs will continue to increase while available resources, physicians and medications will decrease nationwide. (Long, 2012)

The Medicare and Medicaid systems were intended to be an integrated uniform healthcare system based on need rather than privilege . (Hammaker, 2012). . In this tiered healthcare system only those that can afford it have access to the latest medical technology and treatment options. For those who cannot afford this level of healthcare service - the current system appears unjust..

The impact of improving cost-based reimbursement and quality incentives could make basic preventative care more affordable which ultimately could decrease the number of uninsured and underinsured. (Hammaker, 2012) Providers would be more likely to provide the most innovative



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