Pondering the ACA: Medicare Changing Payment Models

You may have heard about Medicare altering how providers get paid. You may have also wondered if it matters or you should care. The answers are a resounding “yes!” to both questions. The change projected by the Obama Administration is ambitious and huge over the next 4 years.

The functional difference in payment is for patient care outcomes. Providers that achieve better patient outcomes get paid accordingly, rather than just being paid for doing more. This is a huge change. The ACA had this concept as a central goal, although it is not talked about (or even recognized) as a focus.

According to the new goals, Medicare will make 30% of its direct payments to doctors, hospitals and other providers via this alternative model starting next year (LATimes.com) It is unlikely the case before the Supreme Court (King vs. Burwell) will change this process. This means nursing care based on evidenced research leading to improved patient outcomes is more important than ever! Medicare is expected to pay out more than $600 billion for medical insurance to 50 million elderly and disabled Americans. Some private Medicare Advantage plans (private insurance) are already using alternative payment plans which reward better-performing hospitals and physicians. What does this mean for your nursing practice in your facility?

Learn more: LA Times.com/business

Posted by Susan Odegaard Turner- MentorRN