This country’s healthcare industry will require some innovative and creative approaches in the future. The economic and institutional environments in which hospitals in the United States have operated have changed dramatically over the last two decades. According to the American Hospital Association, government-mandated cost-cutting initiatives, movements from cost-based to prospective payment, increased control over managed care plans, and medical technological breakthroughs that decrease inpatient treatment have put significant pressure on hospitals. To put it another way: They’ll be out of a job if nothing is done soon. If health care institutions follow laws, patients and communities may be confident that their health care needs and treatments will be met in a safe environment (D’Apolito et al., 2020). In today’s healthcare environment, advanced information technology is needed. It is now necessary to safeguard the sustainability of healthcare services. Healthcare providers must have access to high-tech information systems in rural and suburban areas. As a result of this advancement, doctors will make more accurate diagnoses. Even if a hospital’s services are outsourced, patients may still need to be transported there from time to time. As a result, success depends on having new and improved IT systems.
The Centers for Medicare and Medicaid Services (CMS) has authorized the Comprehensive Care for Joint Replacement (CCJR) bundled payment plan to eliminate payment variance for joint replacement in US hospitals. The principal funding sources for this program are Medicare and Medicaid (CMS). Several stakeholders are worried that the effort would punish hospitals for participating due to the absence of a mechanism for accounting for the medical complexity of the program’s patients. The target episode costs are calculated by taking the average of what other hospitals in the same area have previously spent on episodes of care. This program differs significantly from previous CMS bundled payment demonstrations. The target episode costs are calculated by taking the average of what other hospitals in the same area have spent on episodes of care (such as the Bundled Payments for Care Improvement initiative). The program’s emphasis narrows as it continues, finally concentrating on a single issue. The whole price structure of the program is predicated on the amount of money spent on regional episodes during the fourth year. CMS aims to establish target pricing based on the geographic area to eliminate the wide range of payment discrepancies generated by differing practice patterns in different places (such as post-acute care usage). Orthopedic services are experiencing the burden of rising demand after the opioid epidemic.
Over the past few decades, there has been a significant increase in opioid usage, and the risks of non-therapeutic opioid diversion have increased. The use of opioids, both medicinal and non-therapeutic, in the orthopedic sector endanger patients’ lives. According to the Centers for Disease Control and Prevention, orthopedic doctors are the third most common prescribers of opioids in the United States (Fisman et al., 2020). Because the hazards of opioid misuse are becoming more well known, orthopedic surgeons must learn how to identify patients at risk of non-therapeutic opioid usage. In addition to the methods listed above, others are available, such as medication monitoring programs, abnormal behaviour detection, and opioid risk assessment tools.
Impact on the Healthcare System
Health policymakers, legislators, and clinicians are concerned that hospital-based clinicians may be incentivized to prescribe and administer opioids inappropriately, contributing to the country’s ongoing opioid epidemic. Hospital doctors and nurses believe that their work contributes to the spread of the opioid epidemic. Overdoes are more likely in opioid-naive patients and those with an opioid use disorder (OUD). According to our findings, administrators should concentrate their efforts on the emergency department to reduce the number of opioids prescribed inappropriately. It is critical to investigate the efficacy of various interventions proposed by healthcare providers to reduce inappropriate opioid use in hospitals.
In light of these concerns, a comprehensive, independent evaluation that takes a broad view, including those within a specific payment model and the populations in which they reside, is essential. Depending on the circumstances, accountable care organizations (ACOs) may or may not significantly contribute to lowering costs and improving patient care. ACOs, on the other hand, may aid in healthcare system consolidation and price increases for commercial payers. Increasing the number of Medicare patients or commercially insured patients in those markets, on the other hand, may result in an overall cost increase if the number of bundle payments is reduced within an episode.
Legislation
CMS should adopt the proposed modification to the high-episode expenditure ceiling during the reconciliation process. The government imposed a high-episode expenditure restriction to protect hospitals from being held accountable for catastrophic episode spending that they could not have reasonably predicted. CMS restricts the amount of money spent on each episode to two standard deviations above the mean (Wallin & Fuglsang, 2017). CMS’s approach should be altered since the 99th percentile of episode expenditure should be capped. According to the organization, this will more appropriately represent the expenses of occasional and probably inevitable difficulties in the future.
CMS must finalize a final version of the plan to decrease the number of yearly reconciliation periods from two to a single six-month reconciliation period. Expired claims that overlap with other models do not need to be kept open for the full 14 months to be fully collected. On the other hand, CMS considers that six months is ample time for recording episode expenses. Reducing the number of reconciliations will lessen the administrative strain on the agency and hospital staff members.
Because healthcare expenses are a social burden, the federal government should continue adopting payment and delivery changes to decrease waste in the present healthcare system. Success should be assessed in healthcare quality and cost growth in the United States. The treatment of drug addiction disorder is controlled by several laws, norms, and regulations. The use of telemedicine in treating drug addiction disorder is no exception. Thanks to an amendment suggested by the Secretary of Health and Human Services, drug use disorder and co-occurring mental health problems may now be treated through telehealth (HHS) (HHS). The Secretary must submit a report describing the effect of telehealth on occurrences such as overdose fatalities and trips to emergency rooms within five years of the program’s implementation (Vogenberg & Santilli, 2018, p. 48). It is allowed as long as this condition does not clash with state licensing rules. A patient’s state of residence is required to license Telehealth providers.
States will be eligible for federal funding for drug addiction disorder treatment and telehealth services during the first year of implementation, according to the requirements of this Act. Medication-aided therapy (MAT), medication control and counselling are among the alternatives available for treatment. Individuals with a severe mental illness and a drug addiction issue who are American Indians and Alaskan Natives and those under the age of 40 are among those targeted.
Within one year of the legislation’s passage, the Justice Department must release a regulation outlining when clinicians prescribe restricted medications through telemedicine. Providers who prescribe medication through telemedicine are likely to gain from this clarification of the procedure. Medically-assisted treatment (MAT), short-term inpatient treatment (STIT), and prescription drug monitoring programs (PDMPs) will be covered by Medicaid under the Act (PDMP). Opioid therapy, bundled payments, and electronic health records are all part of the plan. Opioid use disorder treatment, including methadone and counselling, would be covered by the federal government if states choose to.
References
D’Apolito, R., Faraldi, M., Ottaiano, I., & Zagra, L. (2020). Disruption of arthroplasty practice in an orthopedic center in northern Italy during the coronavirus disease 2019 pandemic. The Journal of arthroplasty, 35(7), S6-S9.
Fisman, D. N., Bogoch, I., Lapointe-Shaw, L., McCready, J., & Tuite, A. R. (2020). Risk factors associated with mortality among residents with coronavirus disease 2019 (COVID-19) in long-term care facilities in Ontario, Canada. JAMA network open, 3(7), e2015957-e2015957.
Vogenberg, F. R., & Santilli, J. (2018). Healthcare Trends for 2018. American health & drug benefits, 11(1), 48.
Wallin, A. J., & Fuglsang, L. (2017). Service innovations are breaking institutionalized rules of health care. Journal of Service Management.