All goals that the ACA work towards, why it was created, holds very high standards with good reason since it involves patient care. But what I feel holds the most impact on hospitals are improving quality of care. I believe once you provide quality care from the start with a patient, it can lead to decrease in admissions and complications which can provide an advantage towards an increase in patients as well as obtaining a better “payment structure that reimburses hospitals based on the quality of care provided.” This payment structure holds “hospitals accountable in case of any events taken place in their facilities as well as requiring a more strict quality standard.” And by consistently following quality standards, hospitals are likely to receive incentives and rewards, which will help their revenue and bottom line. “Although the ACA expands affordable coverage options for millions of Americans, the Congressional Budget Office estimates that 31 million U.S. residents will remain uninsured by 2024.” This information may seem as though the ACA’s goals are not being reached, but I’m sure if by 2024 you look at the numbers from 10 year prior, you will see an increase healthcare access as well as coverage cost through the different insurance options, private or through the market place.
1b
I believe uncompensated care costs, such as the Disproportional Share Hospital (DSH) payment reduction in the Affordable Care Act, will have the greatest impact on hospitals. The DSH payments provide hospitals with payment for uninsured patients. As of 2014 this payment will be decreased by 75%, which will significantly hurt hospitals because there is no guarantee patients that are uninsured will enroll in Medicaid or Medicare or purchase another type of insurance. 41% of government payments for uncompensated care come from these DSH programs. If a significant amount of people do not enroll in an insurance exchange program but seek medical treatment in a hospital, that were once dependent on DSH reimbursement, the hospital will face financial shortfalls. As mentioned in the PowerPoint “Impact on Hospitals”, DSH payments have been active in maintaining a strong bottom line for hospitals, especially those that treat a significant portion of uninsured patients. Hospitals that are impacted by payment reduction will have a difficult time with their yearly projections as well, since there will be no guarantee of how many people will be uninsured and in turn how much the hospitals will be compensated for uninsured patients Cut to Medicare Reimbursement is another part of the Affordable Care Act that I believe will have great impact on hospitals and providers. As mentioned in the “Impact on Hospitals” PowerPoint, Medicare will account for a great portion of hospital reimbursement in large part due to the aging baby boomer population that is expected. The combination of the expected baby boomer population that will start to use Medicare, as well as the DSH payment reduction, will have hospitals and providers facing dire financial situations.
2a “The jury found, by a vote of 10 to 2, that HHC’s security measures were reasonable”. I do not believe that the security measures were reasonable. I think they were inappropriate, unprofessional, and unsafe. “As a practical matter, the concern with security had to be balanced against the need for access and movement of patients, visitors and hospital staff. One noteworthy security problem was the employees’ habit of taping or jamming stairwell doors open to permit easy access between floors, since the elevators were slow. Employees persisted in this habit despite constant instructions to cease. Security personnel were placed on notice of the problem and were directed to constantly look out for it, rectify it if possible and if not, to note the need for repair in an incident report to maintenance and in their memo books. Hospital policy as to intruders required employees to notify security of any sighting of unauthorized persons. Security personnel would question such persons, check out their explanations if necessary, and, in their discretion, could arrest them, escort them out of the building, escort them to the proper treatment area or take other appropriate action”. Security knew they had to look out for the locks on the doors and doors being jammed, they failed to do so in this case. They failed to keep employees safe. “The security officer was unaware of Smith’s recent arrest at the hospital and took him to an emergency services walk-in clinic. Testimony by the then director of security for Bellevue, as well as by an attending psychiatrist at Bellevue, indicated that at this point there should have been some concern about how Smith got to the 21st floor, about keeping Smith out of the hospital, and that perhaps a description of him should have been circulated to some extent among hospital staff”. “While witnesses for HHC stated that a description of Smith was not circulated to all hospital personnel after his arrest for the January 1, 1989, they also stated that such a procedure would be “unwarranted”, since Smith was a patient and would have to he permitted on premises for treatment despite the fact of his arrest. The witnesses conceded that such security measure might have been appropriate for the 16th and 17th floors”. I do not believe this would have been unwarranted, I think this would have been totally appropriate under his condition and circumstances. I believe that everyone should have been aware of Mr. Smith’s recent arrest and that his information should have most certainly been shared throughout the hospital, specifically with the emergency room staff. Knowing that Mr. Smith got himself to the 21st floor should have placed enough concern to place him on a one-to-one watch. Although it was proven in court that the security of the hospital met its standards, I strongly believe they did not meet their standards by not spreading concern about Mr. Smith, not checking the doors, and not questioning how he got to the 21st floor. I think that hospitals need to amp up their security system and policies. Although it is stated that it does not have to be flawless I think it should be somewhat close to it. I think it is super important to protect hospital employees who come in everyday to provide exceptional care to patients who are ill and risk their lives coming into work. I believe that security could have done a better job at preventing this incident from happening. The hospital could have prevented this incident from happening if they had a better security system along with better protocols. If they would have spread concern about Mr. Smith more employees would have been aware and the proper action could have taken place. I truly believe Mr. Smith could have been prevented from getting onto the fourth floor where Dr. Hinnant was sexually assaulted and murdered if security would have checked on the doors and locks.
2b
After reading Document Number “A” Eric A. Johnson, Individually and as Administrator of the Estate of Kathryn Hinnant Johnson, Deceased, Appellant, v NYCHHC, Respondent, et al., Defendants, I agree with the dissenting opinion of J Rosenberg. I disagree with the jury’s verdict and the trial judges decision in deferring with this verdict. The law does not require that the hospital act as an insurer and that its security system is allowed to be flawed. The jury came to a conclusion in a vote of 10 to 2, that HHC’s security measures were reasonable. But Steven Smith still sexually assaulted and murdered Dr. Hinnant and I feel that the security system was negligent if something as horrific as that can happen under their supervision. The record states that the jury found the defendant had set up a reasonable security plan under the circumstances and implemented that plan to the best of their abilities. And in doing so, it fulfilled its legal obligation to plaintiff’s decedent. The defendant had employeed 65 to 70 security personnel and they tried their hardest to keep the enormous facility secure. But there were kinks in their system. There was a lot of traffic from the shelter to the hospital and from floor to floor. Security had made the mistake of taping these access doors and stairwells open or jamming it so that the foot traffic can easily maneuver from building to building, floor to floor. This would be the beginning of the demise for poor Dr. Hinnant. The entire plant was 1 million acres and the new building, where the Dr. Hinnant was attacked while working, each floor in the 22 floor building covered approximately an acre. There was also a tunnel that connected the basement to the basement of the homeless shelter. More security should have been stationed at the entryway between the building and the shelter. It is an extremely large facility and I feel it was understaffed and security was a bit too lax for an enormous plant. But I also do not feel that the security system is completely at fault. I understand that the security department had a list of other patients who seemed to be more of a threat and that Smith didn’t seem to have any credible evidence of violence towards other, but he did sneak around and was suicidal. His mental state should have been taken into consideration and had him added to the list. After learning about Smith and how unfortunately they released him each time he came into the hospital, I feel like there were poor decision making or a lack of communication between physicians regarding his mental status. The fact that he was posing as a doctor and trespassing proves his mental state was not well and his drug use would also play a sadistic role in his actions.It is scary to think that just anyone can roam the halls and enter restricted areas. Smith claimed he ate in the doctor’s lounge and observed surgeries. How could security and other staff members not take notice to this. I feel that the hopsital could have prevented such an awful occurrence by increasing security staff to properly cover the million acre facility. With this increase in staff the stairwells between the hospital and shelter would have been manned more properly and there would have been less of a risk of a deranged person sneaking in. I also feel that if the physicians communicated more about the many instances that Smith came into the hospital over approximately a 3 week period, they would have seen that he was in greater need of help and would have maybe shown that he posed a threat and would have been put on the security’s list. Even the security director said at the trial that considering Smith’s history they should have had him on a list. In conclusion, I agree with Rosenberg that they should have set aside the verdict and ordered a new trial. It is quite unfortunate that more means for security standards were not set in place for such a large facility. It is also terrible to think that the physicians whom saw Smith over the 3 week period of multiple visits didn’t think to add him to the security list as a risk. In doing so, it could have saved Dr. Hinnant’s life and the life of her unborn child.
3a
With every new regulation that comes at health care professionals, they must fully understand the new rules and how it changes current procedures, train their staff, obtain approval for revised operating policies and systems, and establish methods for compliance documentation (Government Regulation, 19). The more regulations federal, state, and local governments put in place the more paperwork to be filled out by health care professionals. It could become difficult for doctors and nurses to provide the highest quality of care when they have to spend hours filling out regulatory paperwork. Paperwork is not only time consuming for the staff, but patients as well. I’m sure we all hate having to fill out a few pages of forms when we go to a doctor’s office, now imagine the doctors/nurses having to fill out multiple different forms and some with 60+ questions every time a procedure happens. Added government regulation also imposes unfunded costs on hospitals. The costs associated with health services regulation lead to more deaths than lack of health insurance does.
Reference
(PowerPoint: “Government Regulation”)
3b
The consequences of federal, state and local regulation of health care services is paperwork. “As the number of regulations increases, the amount of paperwork also increases” (slide 11). “A medicare patient arriving at the emergency department is required to review and sign eight different forms- just for medicare alone. Each time a physician orders a test or a procedure, the physician documents the order in the patient’s record. But the government requires additional documentation to prove the necessity for the test or procedure. Although the physician made a clinical judgement, the decision-making process- which results in the medical order- must be documented using an established diagnosis assignment process mandated by the government” (slide 13). “Hospital staff must complete a 30-item Medicare Secondary Payer questionnaire every time a Medicare patient comes to the hospital-whether for inpatient or outpatient care” (slide 14). “According to the General Accounting Office, OASIS requires 40 additional minutes of a nurse’s time to complete the initial assessment. Additional staff time is required for supervisory review and data entry” (slide 15). The consequences of federal, state, and local regulation of healthcare services prolong the patient care process. Not only does this reduce patient care but it reduces patient satisfaction. Patients get frustrated, they do not want to spend more than half of their hospital visit doing paperwork, they want to be treated for their issues. Staff members feel the same I am sure, they want to be able to treat their patients as quickly as possible and not spend most of their time doing paperwork. There is a lot of paperwork that needs to be filled out each and every time and it is time consuming.
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