Exam 3 Study Guide
Exam 3 Study Guide REHSCI 1240
Popular in Issues in Health Care
Popular in Health and Human Services
This 6 page Study Guide was uploaded by Alexandra Ruth on Friday January 9, 2015. The Study Guide belongs to REHSCI 1240 at University of Pittsburgh taught by Debora Miller in Fall2014. Since its upload, it has received 162 views. For similar materials see Issues in Health Care in Health and Human Services at University of Pittsburgh.
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Date Created: 01/09/15
Outline for Issues in HC Exam 3 Week 10 Future of HC Reform ACA HC costs will continue to rise yet many people will remain uninsured Access may not increase either lack of PCP s many physicians don t accept Medicare 0 Future models of HC Delivery 0 O 0 Medical home model patient centered care w clinician accountable for the quality of care Community oriented primary care blending primary care with a population based approach Accountable care organizations integrated groups who take responsibility for the overall health of certain populations Teamlet model 2 person team clinician and healthcare professional 1 who functions as a health coach and coordinates the patient s care Connected Health Care Model aims to prevent unexpected illnesses for chronically ill patients works with communication technology patient selfmanagement and distant home monitoring technology Workforce Challenges 0 O O O O O Integrate talents overall health with 1 HC professional Unifying licenses across states Educating PCP s in much wider range of care Other advanced practice professionals should be involved in primary care process All HC professionals becoming experts in geriatric care baby boomers Dealing with racial and cultural diversity in patients Frontiers of Clinical Technoloov Imaging technologies Minimally invasive surgeries Geneticsmappingtherapy Vaccines Arti cial blood 0 Xenotransplantation Evidence Based HC 0 Improving quality while reducing cost Afford 0 quotBest practicesquot or quotproven therapiesquot Some physicians oppose EBP quotcookbook carequot not up for interpretation by the clinicians reduced autonomy Future goals w EBP Incorporate nancial incentives Robust clinical trials Computer based models Eventually incorporate all caregivers of the patient able Care Act of 2010 Democrats for it republicans against it high expenditures Passed by narrow margin When amendment was added about how it would be funded taxation it won 60 votes Process still ongoing 5 years later next year will have to submit proof of insurance to the IRS added an additional 16000 IRS employees TAX PROVISIONS 40 excise tax at time of saleservice on high cost employer sponsored HC 38 tax on net income over 200000 individual or 250000 couples everyone can apply for insurance you may get a tax subsidy or may not depends on income taxable income worth of health ins limits deductions to 2500year was previously 5000 10 increase on fake tanning services 10 of gross income tax calculation was 75 COVERAGE more taxes and funding but more coverage overall 0 extends dependent coverage until age 26 0 requires all persons to purchase health insurance if not l monetary penalties low income persons can get tax credits in order to purchase HC employers will soon be required to provide ins for employees pools of money are allocated to those w preexisting conditions saved to pay for LTC state based health plan exchanges l Obamacare plans probationary periods in jobs allows businesses to have 90 days to provide insurance for employees 0 O expands Medicare eligibility to 138 poverty level increases state tax burden increases federal funding to Medicaid programs and PCP s MEDICARE REFORMS private ins plans offered as an alternative to traditional Medicare Part B outpatient care reduction in Medicare part D plans on closing the donut hole by 2020 pharm co need to offer 50 discount when enrollees reach the donut hole Medicare Payment Advisory Board established to make decisions regarding Medicare under ACA MEDICAID REFORM Reduces payments to hospitals with less insured patients Increases rebates to drug companies for certain drugs prescribed to Medicaid bene ciaries l cause for bias STUDENT LOANS Increased funding for student and family programs Investment in black colleges and minority service institutions Federal government controls student loans no state grants or private sector loans Dependent coverage for those under 26 PCIP covers those with preexisting conditions Health plans required to include preventative and immunization services 320 million in grants to train and recruit healthcare workers health ins credits available to small employers and tax exempt organizations until 2015 Preventative services mandated for Medicare part B outpatient annual PCP checkups at no charge Discounts for those in the donut hole Women s preventative health care services mandated to be covered in private plans DHHS launch pilot studies to establish care delivery and payment methods for accountable care organizations Court struck down the requirement that states expand Medicaid programs BUT additional federal funding is provided to states who expand Medicaid coverage 0 Federal funding provided to states to establish health insurance exchanges health insurance marketplaces set up for consumers to pick and choose their HC plan Updates since 2013 0 Tax penalties for nonenrollment o 2014 1 of income or 95 whichever is higher 4750 for each child or 285 for the family 0 2016 25 of income or 695 0 this fee escalates each year 0 tax penalties to employers for not providing employees ins by 2015 o 30 hoursweek must cover for ins o CURRENTLY 10 million enrolled in insurance plan of their choosing TOLD THEY COULD NOT KEEP THEIR PLAN did not meet minimum standards by the DHHS 0 These people allowed one more year to switch plans Pres Obama 2014 0 Obama referred employer mandates until 2015 0 Obama provided special for the House and Senates HC coverage 0 Individual and small business mandates were not deferred until 2015 FUTURE Anyone in the 139400 FPL federal poverty level can apply for tax credits for health insurance 400 is where you should be able to pay for Denial of coverage because of preexisting conditions is illegal Employers with 50 employees need to have employee insurance 0 Employers with 200 employees must automatically enroll full time employees and continue to enroll existing employees 0 Legal residents must have health insurance 0 4 tiers of health plans 0 bronze silver gold platinum silver most common 70 paid for by the consumer 30 by insurance 0 every plan has to offer 10 core basic requirements peds care ambulatory services mental health etc 0 COST premiums copayments and deductibles increasing 0 Young healthy people not enrolling in large numbers more coverage then they need majority of consumers on health plan marketplace are older adults with medical conditions ACA may fail 30 million people will still be uninsured by 2016 shortage in PCP s physicians could refuse to treat Medicaid patients bc of lack of reimbursement Many people will still rely on emergency care Affordability is an issue AGING IN THE US 13 of the US pop is over 65 Conditions of the pop include arthritis diabetes heart disease injuries from falls osteoporosis overweightobesity 17 are obese High economic impact baby boomers HIGH HC expenditure for this pop Issue Sandwich generation generation simultaneously taking care of kids as well as parents Elderly also becoming more racially diverse blacks highest rate of deathlimitations from hypertension diabetes arthritis Elderly abuse 0 Neglect Emotional Financial Physical Abandonment Sexual Selfneglect This abuse is usually underreported 32 out of 1000 females abused more than men Abusers family members or caregivers 1970 s since legislation no restraints on beds while sleeping nursing care facilities need to do everything to avoid restraints illegal Ombudsman programs advocating for safety in nursing home facilities Informal Home Care 0 Largest sector of home care 2 billionyear 0 CA Family Medical and Leave law being established to give up to 12 weeks off work for caring for yourself or a loved one 0 Mostly females are caregivers l sandwich generation stresses physical emotional martial employment leisure OOOOOO Skilled Nursing Facilities 0 Predominant mode of LTC for the elderly 16 million Americans live in SNF s O 61 funded by public medicareMedicaid 12 out of pocket Assisted Living 0 Primarily personal payments 0 Home Care Services 0 O O O O O Originated as social welfare response to immigrants in cities Formal or informal or both Short term during recovery long term for chronic conditions Goal to decrease number of informal caregivers Medicare compromises 28 of payments received by home care providers private insurance pays for 28 of payments in home care too 0 Getting less common for elderly to die in their own home 0 Technology has an increased impact on HC 0 Respirators vents dialysis chemo can all be done in home now 0 LTC Insurance available nancial security 0 Strategies for LTC O 0000 Increase physical activity Flupneumo immunizations Prevent injuries due to falls Prevent motor vehicle accidents driving classesprograms Manage chronic conditions nutrition screening edu routine exams telemedicine elderly case managers 0 Future of LTC 0 00000 Diversificationspecialization More demand for home health Managed care integrations Higher workforce need Reimbursement challenges Access cost quality equilibrium GO OVER LIST OF PRESENTATION TOPICS ON COURSEWEB
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