The Affordable Care Act (ACA) has far-reaching consequences on the manner in which healthcare services are designed and delivered to the public. First, it is essential to note that the ACA has significantly improved both access and quality of healthcare through its role in expanding insurance coverage. Since its formation, the ACA has sought to achieve three fundamental goals. First, the ACA seeks to make insurance available to as many people as possible. Secondly, it aims to make health insurance more affordable. Thirdly, it makes health insurance more understandable. Amidst these changes, massive improvements have been witnessed as regards the operations in the emergency department from admission to discharge. The discussion will center on the processes that take place during a typical emergency department visit for a consumer under the ACA.
According to the Center for Disease Control and Prevention (CDC), patient visits to the emergency room significantly bolstered in 2014 after the full implementation of the ACA. According to the CDC, the numbers reached a record high of about 141.4 million (Kominski et al., 2017). Of importance is the fact that the ACA comes with guidelines regarding health insurance benefits in a healthcare facility. Initially, each hospital had the power to select the particular insurance plans it would accept in its jurisdiction. As such, the hospital could essentially limit the coverage for the emergency room visits, especially for the cases outside the hospital's network of emergency health providers. Therefore, before the implementation of the ACA, admission into an emergency room would mean financial hardship for individuals who got sick or injured while in their homes. The ACA rules state that all the private health insurance plans available in the marketplace will accord individuals essential health benefits which are uniform across the spectrum. Some of the items included in the list include emergency services, patient services, and hospitalization. Individuals with the ACA have the rights to access emergency room services at any hospital.
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Other than accessing the health facility of their choice, ACA will also ensure that patients visiting the emergency department do not pay higher copayments or coinsurance when acquiring emergency services from an out-of-network facility. During the process of admission, individuals are not required to attain prior approval for an emergency room service given by a facility outside the network of the plan. Before the implementation of the ACA, one would seek approval before they acquired emergency room services from a provider outside their network's scope. When it comes to discharging patients, the ACA has revolutionized the healthcare industry in the US for the better. Initially, insurance under Medicare limited the amount of time one would stay in the emergency rooms (Kominski et al., 2017). The Medicare set out a particular window, and once the patient passed that deadline, the hospital would not continue to receive reimbursement for the insurers. Some patients visiting the emergency rooms are at risk of acquiring other infections as a result of their weakened immunity. Hospitals under Medicaid would hasten an individual's discharge to ensure that they leave before the new infection surfaces. Medicare will not reimburse the hospital for additional expenses.
With the implementation of the ACA, the hospitals have seen an improvement in the operation of the emergency departments. First, better communications are made by the hospital staffs that are aware of the fact that they will be judged by the patient satisfaction survey. A more effective discharge planning will be developed compared to the one seen with Medicare. With the ACA's new guidelines, it is common to see patients receiving plenty of reading materials. They will also receive a phone call once they are at home or in a rehabilitation center to establish how the patient is fairing on. In general, the ACA has improved good customer services that seek to enhance the welfare of the patient in and outside the hospital environment. Hospital discharge is generally regarded as a process where a patient prepares to leave the hospital. Ideally, patient discharge should occur when both the patient and the doctors feel that it is right (Kominski et al., 2017). The decision to discharge should take cognizance of certain measures, including the patient's ability to survive on their own without medical attention. As seen in the case of Medicare, the patient would be compelled by the hospital to leave the hospitals due to the prospects of non-reimbursement. However, the ACA gives them the opportunity to fight the discharge and remain in the hospital until they are completely healed.
After the discharge, the patient will continue with the rehabilitation and, which is tantamount to additional costs. Part of the aim of the ACA is to help the patients once they have gone home. Before the ACA, doctors lacked the financial incentive to prevent patients from readmission into the hospital. Today, once a doctor discharges an individual, they have a financial interest in ensuring that the patient remains healthy in their time at home. With the Medicare cover, the government and the hospitals were concerned with cases of patient readmission. Research has shown that the federal government, through its Medicare program, would use up to $17 billion for trips that patients make back to the hospital (McClelland et al., 2014). With the rise of the ACA, patients are better managed at their homes in a bid to prevent unnecessary hospital readmission rates. It is in this regard that the ACA has various mechanisms to ensure that the patient receives appropriate care and treatment at the comfort of their homes. One of the ways of doing this involves sending nurses and other healthcare professionals to the patient's home to check up on them. With the advent of technology, healthcare workers are better placed to ensure that patients receive appropriate medical care remotely, thus ensuring that they avoid additional hospital visits.
It is also important to note that the ACA covers the welfare of drug addicts who have been discharged from the emergency room to the rehabilitation center. Every year, hundreds of thousands of people are admitted in the emergency room for issues related to addiction and other adverse healthcare conditions that come about as a result of their continued drug use. Before the implementation of the ACA, the rehabilitation health sector experienced a plethora of problems that have since been resolved with this health insurance policy (McClelland et al., 2014). Some of the plans available in the market required an individual to pay via cost-sharing means. Therefore, this means that one would be required to make out-of-pocket payments for both the in-patient and the out-patient expenses. Secondly, most of the plans came with a provision for the deductibles. As such, this meant that the person covered would have to pay the deductibles before the coverage under that particular plan is guaranteed. However, patients discharged from the emergency care facilities will have much-needed benefits during their rehabilitation days. The plans cover the behavioral side of the disease, including the substance disorder treatment. The patient receives to receive coverage for the illness, and the charges are relatively low.
The last stage of the treatment under the ACA involves the acquisition of medication. Spatz, (2010) noted that the ACA has significantly integrated the role of the pharmacist in primary care delivery. It has also made healthcare holistic and improved the levels of coordination. Pharmacists are now part and parcel of the medical home teams, and their roles include improving the high-risk patients and other individuals with chronic conditions in their primary care areas. Martin discusses the critical role that pharmacists have in the ACA insurance policies. He proves this by saying, “Five areas of the ACA focus on pharmacy involvement: delivery systems reform, payment reform and quality, comparative effectiveness research, workforce issues, and the 340B Drug Pricing Program (DPP) (Martin, 2015). Patients will have increased access to pharmacy services through a host of strategies that include medication therapy management and through medical homes. As a consequence, more positive outcomes of patients in the emergency department, including the discharged ones, will significantly improve.
In conclusion, the discussion has centered on the processes that take place during a typical emergency department visit for a consumer under the ACA. The ACA has increased health accessibility in the US thanks to the myriad of benefits that it has come with. During admission to the emergency room, the patient does not have to have a prior appointment. They are entitled to receive treatment in healthcare facilities that are not covered in their network. During discharging, the patient has a much say in when they should be released compared to the initial plans where one would be compelled based on the terms of the deal. Aftercare services and rehabilitation are also covered, thus ensuring that the released patients are in a better place to recover and avoid unnecessary readmission into the hospitals. It is, therefore, crucial to note acquisition of medication has also improved due to the five pillars that have previously been mentioned.
References
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act's impacts on access to insurance and health care for low-income populations. Annual review of public health, 38, 489-505.
Martin, T. S., (2015). The affordable care act and the pharmacist. US Pharm, 40(10), 33-38.
McClelland, M., Asplin, B., Epstein, S. K., Kocher, K. E., Pilgrim, R., Pines, J. ... & Rathlev, N. K. (2014). The affordable care act and emergency care. American journal of public health, 104(10), e8-e10.
Spatz, I. D. (2010). Health reform accelerates changes in the pharmaceutical industry. Health Affairs, 29(7), 1331-1336.
