Provisions in the Affordable Care Act inadequately address the unique needs of Americans receiving long-term services, and in some instances could produce unintended consequences that contribute to poor outcomes, according to an analysis.
For a report that appears in Health Affairs, researchers examined the impact of the Hospital Readmissions Reduction Program, the National Pilot Program on Payment Bundling and the Community-Based Care Transitions Program. Each is designed to enhance transitional care and prevent avoidable poor outcomes among Medicare beneficiaries, but the authors found the benefits are more geared to acute-care patients.
The Hospital Readmission Reduction Program was designed to provide incentives for improvements in outcomes. However, because some frail older adults suffer from multiple conditions and therefore have a higher possibility of readmission, hospitals’ responses could limit access to this population, the authors found. Preferably, they said, hospitals would respond by redesigning care processes that benefit all patients.
The National Pilot Program on Payment Bundling is designed to motivate providers to deliver care in the lowest-cost setting while avoiding expensive post-acute stays. CMS would link payments for multiple services patients receive during an episode of care. Instead of generating multiple claims from multiple providers, the entire team would be compensated with a “bundled” payment that provides incentives to deliver healthcare services more efficiently while maintaining or improving quality of care.
But the program excludes long-term services and support as part of the bundle, meaning providers may simply withhold services to this group past the bundled payment period to realize savings, the authors wrote.
The Community-Based Care Transitions program links community-based organizations with hospitals to improve outcomes and reduce rehospitalizations. However, the authors said, many frail older adults might not have been hospitalized or may not live in geographic regions served by these organizations.
"Because the Affordable Care Act may introduce unintended consequences for older adults receiving long-term services and supports, we suggest additional policies that may address these potential emerging risks," the authors wrote. "Without retooling the payment and delivery systems, reform could fall short of its transformational promise."
The Supreme Court is expected to rule next week on whether all or part of the Affordable Care Act should be overturned on constitutional grounds.
Among the authors of the study are Mary D. Naylor, RN, PhD, FAAN, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing; and Ellen T. Kurtzman, RN, MPH, with the George Washington University School of Nursing.
To read the study on the Health Affairs website, visit http://bit.ly/M7wxPH.
For a report that appears in Health Affairs, researchers examined the impact of the Hospital Readmissions Reduction Program, the National Pilot Program on Payment Bundling and the Community-Based Care Transitions Program. Each is designed to enhance transitional care and prevent avoidable poor outcomes among Medicare beneficiaries, but the authors found the benefits are more geared to acute-care patients.
The Hospital Readmission Reduction Program was designed to provide incentives for improvements in outcomes. However, because some frail older adults suffer from multiple conditions and therefore have a higher possibility of readmission, hospitals’ responses could limit access to this population, the authors found. Preferably, they said, hospitals would respond by redesigning care processes that benefit all patients.
The National Pilot Program on Payment Bundling is designed to motivate providers to deliver care in the lowest-cost setting while avoiding expensive post-acute stays. CMS would link payments for multiple services patients receive during an episode of care. Instead of generating multiple claims from multiple providers, the entire team would be compensated with a “bundled” payment that provides incentives to deliver healthcare services more efficiently while maintaining or improving quality of care.
But the program excludes long-term services and support as part of the bundle, meaning providers may simply withhold services to this group past the bundled payment period to realize savings, the authors wrote.
The Community-Based Care Transitions program links community-based organizations with hospitals to improve outcomes and reduce rehospitalizations. However, the authors said, many frail older adults might not have been hospitalized or may not live in geographic regions served by these organizations.
"Because the Affordable Care Act may introduce unintended consequences for older adults receiving long-term services and supports, we suggest additional policies that may address these potential emerging risks," the authors wrote. "Without retooling the payment and delivery systems, reform could fall short of its transformational promise."
The Supreme Court is expected to rule next week on whether all or part of the Affordable Care Act should be overturned on constitutional grounds.
Among the authors of the study are Mary D. Naylor, RN, PhD, FAAN, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing; and Ellen T. Kurtzman, RN, MPH, with the George Washington University School of Nursing.
To read the study on the Health Affairs website, visit http://bit.ly/M7wxPH.
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