The Patient Protection and Affordable Care Act, often referred to simply as the ACA or Obamacare, was signed into law on March 23, 2010. The ACA is intended to expand access to health insurance coverage for millions of uninsured Americans by expanding eligibility for Medicaid and developing health insurance marketplaces where uninsured persons may be eligible for subsidies to make private health plans more affordable. While expanding access to health insurance is a big part of the ACA, there are many other purposes of the law, including provisions intended to reform the health care delivery system to produce better patient outcomes at lower cost.
AOTA was very active in the legislative process leading up to the passage and signing of the ACA, working to achieve victories such as inclusion of rehabilitation and habilitation in the essential health benefits package. AOTA has also been monitorting the regulatory process at the federal and state levels as the ACA has been implemented, and has been advocating for occupational therapy practitioners and consumers. The dynamic environment created by health care reform creates opportunities, but vigilant monitoring of implementation activities and carefully executed advocacy efforts are necessary to ensure occupational therapy is valued and protected in the future.
Please also see the Health Care Reform Implementation page on AOTA's website at: http://www.aota.org/Advocacy-Policy/Health-Care-Reform.aspx
AOTA's policy staff read a number of blogs, newsletters and websites to gather information about health care reform, including the blog at Health Affairs.
This blog post reports on a recent survey of hospital executives:
Health Care Reform: Views From The Hospital Executive Suitehttp://healthaffairs.org/blog/2013/12/18/health-care-reform-views-from-the-hospital-executive-suite/print/
Here is a key quote:
"The leaders of America’s leading hospitals and health systems are optimistic about reform (Figure 1 - http://healthaffairs.org/blog/wp-content/uploads/Figure-15.jpg). Fully 65 percent indicated that by 2020, they believe the healthcare system as a whole will be somewhat or significantly better than it is today. And when they were asked about their own institutions, the optimism was even more dramatic. Fully 93 percent predicted that the quality of care provided by their own health system would improve. This is probably related to efforts to diminish hospital acquired conditions, medication errors, and unnecessary re-admissions, as encouraged by financial penalties in the ACA."
It's important to note that the Affordable Care Act isn't just about health insurance exchanges or "Obamacare." The ACA includes numerous provisions that seek to change the health care delivery system. And many of these changes (electronic health records, movement away from fee for service, evidence based practice, focus on quality, etc) were already happening before the ACA was enacted...but the ACA is accelerating change to the system.
In terms of costs savings, hospitals are looking to save money in a number of areas which creates new opportunities for OT. For each of these areas, we will be exploring how OT can help reducte the number of hospitalizations, how OT can reduce the number of hosptial readmissions, how OT can reduce the number of ER visits, etc. (Figure 3 - http://healthaffairs.org/blog/wp-content/uploads/Figure-31.jpg). It important to note that these opportunies are not just in hospitals, but at every point in the health care delivery system. A fall prevented in the SNF prevents a trip to the hospital. A medication routine developed by an OT might prevent a readmission. Having an OT as part of the primary care team could prevent an unnecesarry trip to the ER.
Please send us your ideas!