afforable care act final

Financial and operational impacts of the 2010 Patient Protection and Affordable Care Act on physicians and hospitals

Table of ContentsAbstract............................................................................................................................................3

Introduction......................................................................................................................................4

Review of Literature........................................................................................................................5

Background and purpose of the ACA:.........................................................................................5

Community mental health centres.............................................................................................14

Drawbacks and Limitations.......................................................................................................17

Areas of dissent amongst Health professionals with ACA:.......................................................19

Monitoring and Enforcement of ACA:......................................................................................20

Role of Physicians in the early Implementation Process:..........................................................21

Metrics for measuring the effectiveness of the ACA:...............................................................22

Changes in the Management Roles of Physicians under the ACA:...........................................24

Compensating Physicians under a new healthcare model:........................................................29

Summary of Literature Review.....................................................................................................29

Research Methodology..................................................................................................................31

Findings.........................................................................................................................................33

Summary........................................................................................................................................47

Recommendations..........................................................................................................................47

Conclusion:....................................................................................................................................48

References......................................................................................................................................50

Appendix........................................................................................................................................55

Abstract

The research has been focusing on identifying the various implication of Patient Protection and

Affordable Care Act or Affordable Care Act (ACA) on the physicians and hospitals operating in

US. The research has analyzed the implications of ACA, as well as explored into the perception

of physicians in terms of disagreement they hold with the provisions of ACA. The research has

obtained quantitative data from 30 physicians. The questionnaire has addressed implications of

ACA on the operations, marketing and management related activities of the physicians. The

respondents have been able to provide insight into the perception of medical professionals about

the nature of ACA, the changes required to implement it effectively, and the knowledge of

patients about the provisions of ACA. A list of recommendation has been provided on the basis

of the analysis, including the need to provide training to healthcare providers, focusing on

enhancing the level of coordination among physicians and creation of close coordination

between government and hospital management.

Introduction

The earlier version of US healthcare system has placed the physicians on a controlling

and dominating position, thus allowing them to be the sole decision maker, making judgment

pertaining to quality of medical services and its related fee (Starr, 1982). The historical

overview indicates that physicians have retained a great deal of power previously; however the

changes induced by social, political and governmental forces have shaped the contemporary

outlook of US healthcare system. From 1930s onwards, managed care has gained momentum,

thus shaping the current healthcare system in US (Niles, 2010). As a means to handle the

increased cost of healthcare, the notion of managed care has been introduced to support those

individuals who are unable to afford medical care due to its high cost. Nevertheless, the rising

cost of gaining access to quality healthcare by different socio-economic strata has been a prime

area of concern for the US government (Greenwald, 2010).

The government has passed various legislations to ensure that the US healthcare

industry is able to provide healthcare facilities to those who can’t afford it. The 2010 Patient

Protection and Affordable Care Act (PPACA) which has also been termed as ‘ObamaCare’ is

one such illustration of the changing façade of US healthcare industry (Kenney, McMorrow,

Zuckerman & Goin, 2012). The law related to ACA is expected to become a fully implemented

part of healthcare functioning in January 2014. The paper intends to explore the purpose,

usefulness and limitation of the PPACA. It will also address the issues associated with the

implementation of PPACA as well as identify the financial and operations alterations it has

triggered in the US healthcare industry. Lastly, the paper will analyze the pattern through which

patients and healthcare providers have adapted with PPACA.

Review of Literature

This section of the study will focus on reviewing the available researches about the

nature and scope of Affordable Care Act, the expected outcomes of ACA and the areas of

dissent among physicians arising out of the limitations of the act. Moreover, the literature

review will also explore the role physicians can play in the successful implementation of the

ACA based policies in the medical care centres. In addition to this the changing role of

physicians due to ACA has also been explored and the financial implications of such alterations

have also been highlighted.

Background and purpose of the ACA:

The general purpose of the Affordable Care Act is to reduce the number of uninsured

individuals and expand the coverage of healthcare services within the U.S. Clemans-Cope et al

(2012) have outlined the following key aspects of the Act:

a. “Expansion of Medicaid eligibility up to 138% of the federal poverty level

b. New health insurance exchanges for small-employer and individual purchase of

private coverage, with subsidies for individuals with incomes of 138–400 percent

of the federal poverty level

c. Requirement that most US citizens and legal residents have qualifying health

coverage or pay a tax penalty, referred to as the minimum coverage requirement

or “individual mandate” (Clemans-Cope et al., 2012, p. 921).

Kenney et al (2102) found that the increased cost of healthcare services has resulted in a

gradual decrease in the number of patients (aged 19-64) seeking treatment for various ailments.

The results were based on a time span of 10 years, ranging from 2000 to 2010. On the other

hand, the number of children receiving treatment through Medicaid and the Children’s Health

Insurance Program has increased. One of the major reasons why adults do not seek immediate

medical care is the rising cost of such services (Harrington, 2010; Huntington et al., 2011).

By the end of 2007 there were more than 25 million adults who were facing problems in

accessing healthcare services due to affordability issues. Schoen et al (2008) has stated that a

larger proportion of underinsured adult population in US belongs to the middle socioeconomic

strata. The rise in the number of underinsured individuals has occurred at an alarming pace,

resulting in a 60% increase. Similarly the uninsured individuals also pose a challenge to the

healthcare professionals in delivering quality healthcare services to all US residents. Kocher,

Emanuel and DeParle (2010) mentioned that lack of information on part of physicians

regarding whether or not patients are taking medication adversely effects delivering high

quality medical care. Another impediment is lack of incentive to get medical insurance. The

authors have observed that this health care bill will change the way that health care is provided

to the Americans and how they perceive it. The government has introduced many incentives in

clinical practice as well. Morbidity and mortality are observed as the overwhelming outcomes

of poor patient care and being uninsured. Most of the financial barriers to acquiring health care

services has been removed thorough this bill and restricted the use of rescissions that reduce the

chances of people getting medical care when they need the most. Through sustained steps such

as copayments and cost sharing, the act tries to lower the health care expenses for individual

users. The elimination of costs related to preventive screening visits has enabled the patients to

reduce the ailment-related expenses. The act will also help the physicians to track the

medication record of their patients as well as proposing them the appropriate tests and

treatments (Kocher, et al., 2010; 536). The authors have also suggested that the bill is aimed at

reducing the unplanned readmissions as well as medication errors that go unreported. Majority

of health care cost is incurred on treatment of chronic diseases and these can be prevented at

primary and secondary disease prevention centres. It is also observed that the combination of

American Recovery and Re-investment Act with Affordable Care Act will provide more than

$25 billion of incentives to healthcare industry including the hospital to use electronic medical

records (EMR) for patient care management. Reduction in paper work required for insurance

companies is also the main task undertaken through the introduction of proposed health care

bill. Kocher et al (2010) have also summarized the main objectives of Affordable Care Act, the

major provision of the act and the implications for physicians.

Objective: The main objective of this act is to guarantee access to health care for all

Americans. This will be made possible through subsidy coverage and the expansion of

Medicaid. The government will also try to remove the lifetime limits on rescissions. The

physicians will be one group having significant influence from these changes in the health care.

There will be a sharp increase in health care services and surge in non-physician team members

will also be increased in health care provision. Another major objective of the proposed act is

to incentivize the physicians and health Care facilities. With such backdrop, the health care bill

will improve the availability of services and provide incentives to the physicians to provide

integrated health service. The act also proposed to change the way that physicians practice their

profession and provide medical care to their patients.

The medical care programs in the form of Medicare and Medicaid are not sufficient to

fulfil the needs of the increasing population. Apart from adults, uninsured children also indicate

flawed approach of providing medical care. Shane (2010) reported that adoption of a more

effective insurance framework could bring significant improvement in the access of healthcare

for children. This can have positive implications on the number of child mortality, reducing the

ratio significantly. It has been inferred that more than 37 % deaths were avoidable if a more

robust insurance policy was in place. The prime factor in mortality was delayed treatment due

to having no available insurance.

Given the challenge of accessing quality health care for chronic or non-chronic illnesses

by the lower and middle income groups, the government has decided to launch long term

healthcare policies that could promote the access to healthcare for underinsured and uninsured

people. According to Atlas (2010) the basic rationale for the approval of PPACA in March

2010 was to develop a standardized means of controlling the provision of health services,

coverage via insurance and regulate the purchase / usage of insurance policies by individuals,

families and the corporate sector. In essence, the PPACA plans to authorize the federal

government to make decisions pertaining to providing health care services, offering insurance,

pricing of insurance and other healthcare related services. Furrow (2011) observed that patient

care has not improved ever since the report ‘To Err is Human, 2010’ was published. In this

report, the authors had revealed that 44000 to 98000 deaths per year took place due to hospital

errors. This was a staggering figure. Nonetheless, another study that was conducted in ten

hospitals of North Carolina also corroborated the findings of earlier study that patient deaths

due hospital error are still widespread. The study by Furrow (2011) reported four fundamental

safety issues that patients face while being in hospitals. Firstly, patient injury is a frequent

incident in hospitals. Secondly, the bad medicine practice still persists in the hospitals despite

introduction of relatively better medicines. Thirdly, lack of effective practices in hospitals also

negatively impacts the patient safety. Least but not the least, the regulatory enforcements

regarding sharing of patient information through EMR is also not widely implemented. The

authors have also mentioned that six areas of patient care have been focused upon in the

regulatory measures that governments in the recent years have taken. These are standardization

of effective medical practices by the physicians. Tracking of adverse events is also an area that

regulators have incorporated in mitigation measures in their policy. The provider’s performance

is another area that helps administrators assesses the physician performance. Incentivizing the

health care system, both from the perspective of provider as well as the patient was also a

milestone in patient safety in the U.S. Then, the U.S regulators have increased the required

level of coordination and integration within health care stakeholders including the patient,

providers, and insurance agents. The last Affordable Care Act has significantly expanded the

responsibility of provider and it includes several legal requirements that provider needs to fulfil

while providing health care. Corporate governance of hospitals will also be made more

accountable as compared to previously. The author mentioned that there are several initiatives

that Obama administration took through the Patient Protection and Affordable Care Act

(PPACA). Firstly, disease management was introduced and preventive disease management

was made the focus of this program. Private insurance market was reformed and new payment

models were introduced through PPACA. There was an increased and focused policy making

towards prevention of mistakes and errors at the hospitals. Medical practice guidelines were

made central part of PPACA and the stimulus bill called American Recovery and Reinvestment

Act 2009. Standardization has also been a focal point of regulatory efforts through PPACA.

The author mentioned that section 3013 in particular determines that quality measures shall be

developed to assess the provision and management of health care. Quality measures are the

standards that government has established for managing the patients. Standardization of

physician practice remains the main aim of this act and the regulator will try to bring effective

practices being followed across the health services sector of the U.S. The act will help

eliminate the existence of self-interested medical society. The act will also enable incorporation

of evidence based intervention in the medical practices of physicians. Disclosure of provider

performance by the hospitals is also an important outcome that PPACA act aims to achieve.

This will help track the performance of providers and enable improvement in future. Bulk of

the research being carried out regarding healthcare reforms indicate that primary care is an

important field within healthcare where the government needs to focus more as compared to

tertiary care. For this purpose to be achieved, the U.S federal government through PPACA

launched the initiative of Patient-Centred Medical Homes (PCMHs). The PCMHs will be

community based health care facilities where physicians will use the health information system

to manage the patients and receive additional service payments. Through the adoption of

PCMH, fragmented health care service delivery mechanism will be unified under one medical

facility. Thus, the bulk of literature that we have reviewed so far emphasizes the role of

PPACA as an integrated and coherent macro approach of the government in dealing with health

care issues.

Another major benefit which the government has envisioned arising out of the

application of ACA is that patients will have a higher probability of adhering to the

recommended medicine and course of action as directed by the physicians (Kocher, Emanuel &

DeParle, 2010). Currently a significant number of patients fail to comply with the instructions

issued by their physicians due to the financial limitations in gaining access to the needed

medical care.

Kocher, Emanuel and DeParle (2010) have stated that the removal of annual and

lifetime limits can instigate improvements in the delivery of healthcare as individuals dealing

with chronic illnesses or leading long term medical attention will not be facing such

obstructions. Apart from that some of the medical facilities will be put forward as free of cost

services, for instance preventive screening for ailments such as cancer can significantly

improve the chances of delivering the needed treatment on time. However, offering free

screening services will require financial funding.

Hoffman (2011) analyzed ACA in terms of the theoretical framework of rationale for

offering insurance to the people. It has been stated that the policies of Affordable Care Act

have been devised keeping the value of care into consideration. For instance, the high value

care such as preventive screening is a focal point for insurance. On the other hand low value

health care such as end of life care doesn’t seem to reflect the similar level of emphasis.

Hoffman (2011) has also noticed that ACA is also likely to increase the number of people

accessing preventive care as the act will put a stop to the practice of copayments received by

the insures. The individuals seeking preventive screening tests will be able to go through these

tests without paying a high sum of money. Since the medical care costs have increased

manifold since last one decade, the PPACA will help the financially insecure segments of

society to avail the medical care. The shifting of financial burden of unavoidable risks related

to health will also help the individuals to manage finances and health simultaneously and

without bankruptcy. In addition to this, issuing subsidies is also expected to reduce the

occurrence of medical bankruptcy (Oechsner & Schaler-Haynes, 2010). From saving

Americans from medical bankruptcy to sharing the financial burden of chronic diseases, the

affordable care act will provide a much needed integrated framework for health care and

insurance bas3ed management of health.

Another defining feature of ACA is that it emphasized insurers from treating the

applicants on equal grounds. However, an exception has been allowed in cases where the

applicant is explicitly found to be indulging in behaviours that increase the vulnerability to

develop illnesses. In such a context, the patients may be required to pay more than other

patients who haven’t depicted such risk taking behaviour in terms of their health and wellbeing

(Hoffman, 2011).

Buck (2011) observed that substance abuse is also an area of healthcare that has

benefited from the Affordable act. Funding and service delivery will improve as the federal and

state governments will increase their input into the insurance based program of healthcare. The

author has also suggested that mainstream health care spending should also be integrated with

substance abuse. Reforms will also increase in the substance abuse aspect of health care

system. The author observed that despite being treated separately in medical facilities, the

adverse impact of such practice should be abolished in near future. There are other issues in the

substance abuse healthcare management. The funding anomalies have been identified as the

main impediment in treating such patients. The author identified that 40% of the non-profit

facilities do not accept the Medicaid and private insurance. Further, NPOs do not have any

agreements with managed care providers for the substance abuse patients.

The Affordable Care Act will also impact the way that financing is conducted for the

substance abuse treatment service. The primary care strengthening will result in an improved

service delivery for the substance abusers as well. The person will be oriented to the health care

in a more integrated and coherent format as compared to before. The creation of medical homes

will result in increased substance abuse incidents and thus more number of people may be able

to take advantage of the situation.

Federally qualified health centres will also be increased in context of their funding by

the government. $11 billion have been proposed as additional funds to the health centre

programs and this will be executed with the time period of 2011-2015. Medically underserved

people will be made part of this extensive net of medical homes and health centres. This will

result in an increased need for physicians and paramedics. The impact that these changes will

make in context of substance abuse treatments centre is also positive.

Since expanded number of people will be covered under the substance abuse insurance

covers, it is assessed that primary care-based approach to treatment of such patients will

increase. It is also estimated that the largest section being the beneficiary of this act will be

substance abuse disorders category. This will also increase the likelihood of increased

treatment in case of relapse of these patients. Supplemental security income as well as social

security disability insurance will also help the people in the category of nonelderly childless

adults. The persons with substance abuse disorders are usually denied such insurances and this

act will alter this practice of denying insurance to substance abuse disorder people.

The people whose income will be below 133% of the federally declared poverty level

will also be able to benefit from the affordable care act by obtaining insurance for substance

abuse disorders. The people with substance abuse disorders have got affected

disproportionately with a reduction in state spending on health care. It was estimated that 3.8

percent of reduction took place in 2008 and 7.3 percent in 2010 in the healthcare funds.

Overall, the coverage for substance abuse will be increased from the existing level. The

relative funding sources for the substance abuse treatment facilities and the human resource

requirement in these facilities will also be increased. Under the Medicaid program, the size of

substance abuse treatment facilities will also be changed. The main attributes of this program

are also the near universal coverage of patients through insurance covers along with increased

use of health information technology to prescribe and observe the medication.

Community mental health centres

The main motivation for increasing the treatment of substance abuse patients will be for

the community based mental health centres. The incentives provided in the act will help these

centres to improve their service delivery and integrate the service to other healthcare facilities

as well as insurance providers. Access to wide range of mental health facilities and mental

health facilities will result in an improved personal care to substance abusers.

The non-specialty care providers will also benefit from the act as the funding and

insurance coverage will increase starting from 2011. The number of these centres will also

increase in the forthcoming years. The guidelines of National drug control strategy will also

help these centres to improve their services and integrate them with the mainframe health

facility providers.

It is also observed that through the introduction of Affordable Care Act, the interest in

Accountable care organizations (ACOs). The ACOs are the new payment model for the

Medicare. It is also observed that this will not only encourage the private clinics but also the

Medicaid covered clinics to adopt the ACO as the payment source. The growth in spending on

healthcare will be stimulated by this introduction of ACOs (Fisher & Shortell, 2010).

Physicians as well as the hospitals will not only benefit but the number of facilities benefiting

from such service will also increase.

Orszag and Emanuel (2010) observed that primary-care in the United States needs

immediate attention. The primary care residencies have dramatically reduced during the last

few years. High quality care and prompt service to the patients is denied when primary care

physicians are overworked. The authors have observed that through PPACA the American

health system has now been reformed as was required since long. The cost control elements in

the act are vital to the success of this law. The elimination of unnecessary cost is also a main

aim of the enacted act.

Administrative simplification of the healthcare system is also an intended purpose for

which the bill was introduced. Unnecessary paper work and other elements such adoption of

electronic medical records and rules will allow the administration to focus on main aspect of

their service delivery. An estimated $20 billion will be saved by the federal government over a

course of 10 years by adopting the EMRs. The overall inflation rate will be reflected in the tax

rate of premium of insurances. The integration and adoption of research findings regarding best

and effective practices will also help reduce the economic cost of bad practices.

Horizontal coordination amongst the providers is also supported in the act. The criteria of

constant monitoring of the patients after medication will allow the physicians to restrict the

healthcare cost to minimum. The health care delivery system will be redesigned and this will

help the providers to better manger their practice.

Medical homes and Accountable health care organizations are part of this redesigned

system of health service delivery. The hospitals that report risk associated readmissions will be

penalized if proper care is not provided in the first/initial visit of the patients. $500 million and

above have been provided under this act that will help the hospitals manage the patients beyond

30 days. The changes in information delivery and infrastructure will result in improved

outcomes in the healthcare industry. The independent payment advisory board (IPAB) will

ensure that per capita cost of the system does not increase from the inflation adjusted threshold.

These changes will allow the systematic eradication of economic as well as management

related inefficiency that costs to the health care system and the federal and state government.

The flow of information within the healthcare system will be made transparent and real

time. This will help the physicians to address the main issues that patients face regarding

relapse of major diseases and the readmissions rates will also decrease over a period of next

few years. The cost of managing healthcare due to an increased rate of readmissions also

increase manifold. To avoid maximum possible readmissions, the government has not only

incentivized the healthcare sector but also introduced regulations that will make it mandatory

for the practitioners to adopt these changes. Thus, the PPACA will benefit the people and the

economy of the nation in two ways. Firstly, the number of people that seek preventive

healthcare services as well as primary and tertiary health service will increase during next few

years. Secondly, the cost of all these services will decrease as compared to the current costs.

These elements along with other sophisticated measures that Obama administration has taken

will help reduce the overall medical bankruptcies in the U.S.

Drawbacks and Limitations

Despite the potential benefits carried by the Affordable Care Act, its critics have

highlighted some of the limitations the can reduce its expected degree of effectiveness in

improving access to healthcare across all socio-economic classes and ethnic groups residing in

USA.

One of the key drawbacks evident in the implementation of ACA is that the heightened

control over insurance mechanisms may result in limiting the access of patients to healthcare

facilities (Battistella, 2010; Wolf, 2011). The intervention from government to encourage

individuals in purchasing insurance policies may reduce the chances of medical treatment being

delivered to uninsured people and their families. Breen (2012) has further elaborated this notion

by suggesting that effectuation of the ACA will only benefit the documented cases, while the

Act will exclude undocumented cases from gaining access to the basic or primary level of

healthcare services.

Another limitation of the Act is that it doesn’t take the healthcare infrastructure into

consideration. The improved access to healthcare facilities will result in an increased number of

patients, however, the resources required to handle the influx of patients isn’t sufficient to cater

to their needs (Breen, 2012). Bustamante and Chen (2011) on the contrary have argued that the

implementation of the ACA will support physicians in providing quality treatment to non-white

patients who are currently unable to obtain the same level of treatment quality as offered to

white patients. Schoen et al (2011) asserted that the successful implementation of ACA would

address the affordability issues being faced by people who are underinsured, thus resulting in a

70% decline of such cases. Moreover, the number of uninsured individuals is also likely to

reduce significantly.

ACA has also failed to address the mechanisms for cost controls in clear terms, thus

creating confusion among the physicians about the reception of monetary return on the services

they have rendered. Moreover, the lack of cost control in case of purchase of medicine also

constitutes a dominant flaw in this plan (Murphy, 2012). The main emphasis of the Act has

been on increasing the number of insured individuals, considering it to be the only way through

which healthcare coverage for the masses can be improved. However, such as approach carries

the risk of overlooking the means of providing such insurance. Individuals who do not have

insurance currently will have to purchase insurance from private companies or pay a penalty.

Absence of a public insurance company gives leverage to the private firms offering insurance

to focus on profitability, thus reducing the possibility of decline in healthcare cost (Murphy,

2012).

Davis, Abrams and Stremikis (2011) have also supported the implementation of ACA

on the grounds that it would encourage physicians to extend quality healthcare services to a

diverse range of populations. Furthermore, it has also been argued that ACA can be a source of

increased spending from the US population in healthcare as well as a heightened level of job

satisfaction among health care providers. Nevertheless, the problems of increased responsibility

of healthcare providers as physicians and managers can be an evident drawback that needs to be

addressed.

Areas of dissent amongst Health professionals with ACA:

The healthcare professionals have viewed ACA with disdain, deeming it to lack the

possibility of alignment with the existing healthcare model and practices (Gardner, 2012). The

physicians are of the view that currently the undocumented people and families are able to gain

access to the healthcare facilities, alongside the documented ones. The implementation of ACA

will increase pressure on the existing healthcare model to tend to the need of the documented

patients only, thus increasing the troubles of the undocumented individuals and their families

(Block et al., 2012; Frenkel, 2010). On the other hand, Kocher, Emanuel and DeParle (2010, p.

538) have argued that ACA will support the physicians to “evolve the way in which they

deliver care”.

Epstein and Stannard (2012) further argued that the effectuation of ACA will

inadvertently propel individuals to opt for choices within the domain of medical insurance

against their will. Another condition associated with the implementation of ACA, which has

raised a great deal of criticism from healthcare providers, is the possible loss of government

support for current Medicaid ventures, in case of noncompliance to the policies of

‘ObamaCare’ (Epstein & Stannard, 2012; Wilensky, 2012). Thus, healthcare providers will be

driven to either face the loss of governmental funding for their Medicaid activities or accept the

provisions of the Affordable Care Act.

An evident limitation in ACA is that it has failed to take into consideration the

additional costs the healthcare providers will have to incur after implementation of the

‘ObamaCare’ policies. Physicians have further identified the lack of emphasis on the quality of

healthcare as the most predominating flaw in ACA. As a result, the expected outcome of the

policies related to ACA may have an impact on the number of people using Medicaid,

however, the quality of treatment and services they receive will remain an overlooked area

(Huntington et al., 2011; Jacobson & Jazowski, 2011; Long & Gruber, 2011).

Monitoring and Enforcement of ACA:

Another area of consideration for the government and healthcare providers is the

enforcement of ACA and monitoring the process of implementation of the act within hospitals.

According to Belmont et al (2011) the hospital boards can play an important role in the

adoption of policies that support them in integrating the various domains of healthcare into a

unified cohesive network of medical care. In addition to this, to supplement the process of an

effective implementation of ACA the government will also monitor the progress of medical

care centres.

The federal governments as well as local governmental bodies in different states are

required to keep track of the application of ACA in the various Medicaid centres, directing the

healthcare providers to implement the provisions, as well as penalizing those who fail to adhere

to these standards (Cole, Lerner & Mann, 2011). Therefore the coordination between

government and management of medical health centres plays an important role in the proper

reinforcement of the act. The coordination between government and hospitals will give rise to

shared understanding of the healthcare objectives thus resulting in the development of

institutional policies that are aligned with the provision of Affordable Care Act.

Rosenbaum (2011) has stated that the State insurance departments will also hold a

prime position in the implementation of the regulations and policies associated with ACA. The

insurance departments established in each State have the jurisdiction to put into effect the key

policies of ACA. On the other hand, the limited power of the Federal government in the

effectuation of the Affordable Care Act is also an area of debate as the Federal government

needs to align its implementation efforts with the 10th amendment of the Constitution.

Forceful implementation of ACA will be a clear violation of the amendment, thus

positioning the federal government at a less powerful stance. As a result of these factors, the

chance of forceful implementation has been curtailed. Rosenbaum (2011) has also found that

the insurance regulations will need to be viewed as a voluntary activity, excluding the notion of

enforcement by forcing the medical health entities to adopt the regulations.

However, certain penalties have been devised to discourage individuals and businesses

from completely refraining from the purchase of insurance. In the case of individuals, they will

have to face a penalty if they do not have insurance for covering their visits to Medical

practitioners. This insurance can be in the form of payment issued by the employer for medical

bills and services and the medical treatment received from Medicaid, Medicare etc

(McDonough, 2012). The penalty in this case will comprise of 1% of their income, which is

deemed as an ineffective means of triggering favourable behaviour from patients (Huntington

et al., 2011). In cases of business entities not complying with ACA, the calculation of the

penalties will be based on the number of full time personnel and their access to exchange and

insurance coverage plans (as shown in appendix, fig 1).

Role of Physicians in the early Implementation Process:

The early implementation process of ACA will be most crucial as Physicians,

Healthcare providing entities such as Medicaid and Medicare will need to demonstrate

flexibility for the adoption of the regulations of the Act. Health care providers will also be

required to be a part of the insurance implementation process through focusing on providing

medical services to individuals who present them with the requisite insurance policies.

Researchers have found that a significant number of Medical students have

acknowledged the requirements to reform the existing outlook of medical care services. Such

an attitude plays an important role in preparing these students as future doctors to embrace the

healthcare reforms put forward by the government (Huntoon et al., 2011; Cullen, 2012;

Sommers & Bindman, 2012). The support obtained from Physicians will definitely help both

Federal and local governments in the successful implementation of ACA. On the other hand,

the lack of support from unwilling Physicians will create barriers in the effective

implementation of the provisions of the Affordability Care Act.

The physicians will need to make an effort to establish an effectively coordinated

network for providing healthcare services which are aligned with the requirements of

Affordable Care Act. Under common circumstances, the physicians will only concern

themselves with the aspect of illness related to their own specialization. In cases where the

patients are under treatment of more than one physician due to different chronic illnesses, the

situation will require the physicians to be more active in coordinating with each other.

Metrics for measuring the effectiveness of the ACA:

The means of gauging the level of effectiveness of the Affordable Care Act will take

various forms. One of the most useful tools in this regard will be utilizing statistics including

the number of patients seeking medical treatment through Medicare, Medicaid and other public

healthcare service providers. The centralized providing of medical insurance through the

establishment of exchanges will enable the Federal and local governments to obtain ratios of

individuals and businesses who have obtained insurance (Swain & Hudis, 2012).

According to Faguet (2013), the basic premise upon which Affordable Care Act was

established was that the cost of overall healthcare services should be reduced so that the US

residents could seek medical treatment on time. Therefore, the increased number of patients

with insurance will be one of the indicators of effectiveness of ACA. Previously underinsured

people will be provided healthcare access through subsidies, while the uninsured will be

encouraged as well as coerced to some extent to purchase insurance from insurance providing

entities.

Apart from the statistics about the number of patients and insured individuals, the

feedback from Physicians, health care providers and medical boards will also formulate an

important part of the metrics for measuring ACA’s effectiveness. The quality of services

rendered to patients and the savings of cost and time while providing medical treatment will

indicate an overall means of studying the effectiveness of the act (Sugden 2012).

On the other hand, there have been doubts expressed about the capability of ACA to

help individuals from dealing effectively with the increasing cost of medical expenses. It has

been further suggested that despite the provisions that fulfil the medical needs of uninsured

individuals, the issue of medical bankruptcy still needs to be addressed effectively.

Nevertheless, the cases filing for medical bankruptcy can be used as a means of the capability

of the provisions of the affordable care act in reducing the number of such instances.

Atlas (2010) has considered the use of quantitative information in measuring the degree

of effectiveness of ACA to be followed with caution. It has been stated that the commonly held

notion that ACA will lower the cost of healthcare for patients as well as support medical care

institutions in fulfilling the needs of patients by providing the required healthcare services

without being hampered in the course of operations is a misnomer. It has been further argued

that the act may end up increasing the federal deficits.

Changes in the Management Roles of Physicians under the ACA:

The roles of healthcare providers and physicians are expected to be changed, as the

responsibility of aligning the current medical practices with the new provisions upheld by the

ACA need to be handled accordingly. Medical boards can provide guidance to the medical care

providers; however, the management of the operations and financial expenditure of hospitals

remains an area of responsibility for Physicians. Kocher, Emanuel and DeParle (2010) have

provided an overview of the areas where Physicians can play an integral managerial role in

ensuring the appropriate enforcement of the Affordable Care Act.

In order to achieve the goal of providing access to quality health care facilities to all

citizens, Physicians will need to manage the operations of their hospitals with due diligence to

ensure that the high ratio of patients are handled accordingly. Since implementation of the

ACA is going to result in a higher number of people having insurance who would be seeking

medical help, the rise in the number of patients will be needed to be managed by the medical

care providers themselves (Kocher et al., 2010). Therefore, it will require them to manage the

provision of healthcare services, maintain record of patient records as well as coordinate with

other medical care specialists for cases requiring mutual effort for providing treatment. Fiscella

(2011) also investigated that how affordable care act is developed to promote equity in the

healthcare system of the U.S. The author identified some key elements of removing disparity in

the healthcare system.

These are improving the level of access to healthcare, support provided for the primary

and preventive care, inclusion of health information technology (HIT) in the management

system of hospitals, reforming the payment methods to suit the needs of poor people, and

inclusion of research based best practices in provider standard operating procedures (SOPs).

The basic element of any healthcare system, the author observed, must be the effective

alignment of resources with needs of patients. With these elements of redesigning the

healthcare system, primary care must be the vital emphasis of any health care system.

Fiscella (2011) has investigated the reasons of disparities in healthcare system in detail.

Ethnicity, race, and socio-economic disadvantages (SES) are observed to be the main reasons

of disparity in healthcare system. The social disadvantages result in worsened quality of

healthcare that the U.S citizens receive. The author provides an interesting definition of an

equitable healthcare system and defines it as a system where elimination of bias must be

followed by patient-centred healthcare system. Context shall be kept in consideration and after-

treatment monitoring is also as essential as the preliminary treatment of the patient. The author

in this regards has commended the efforts made in the Affordable Care Act as it tries to reduce

the cost of healthcare. The cost differences between behavioural and medical care are, in ACA,

tried to be removed. Key impediments to the effective use of health insurances are some

provisions such as co-payments and insurance deductibles.

An effective healthcare system can only function when primary healthcare is made

available to many of the deserving segments of the society. The provisions of ACA that

mandate the state government to participate in trainings of workforce in medical field and

expansion of health centres will help the government reduce the overall cost of obtaining health

services. Fiscella (2011) observed that minority and poor patients are at most disadvantage

from an inequitable healthcare system. Thus, ACA will gradually include these segments of

society within the insured healthcare system. The strengthening of primary care net will help

these poor sections. Federally qualified community health centres (FQHCs) are specifically

used more by minorities and underserved segments of society. Thus, by increasing funding of

FQHCs, the poor will gain immense level of primary care services. It is also estimated that

more than 20 million patients are served by FQHCs and ACA promises to support FQHCs by a

generous aid of $11 billion. Another important aspect of ACA that Fiscella (2011) identified

were the enhancements in teaching aid of health centres and improvement of payments for the

physicians conducting teaching sessions. The services provided by FQHCs are equally obtained

by all underserved communities. The following figure obtained from the U.S department of

Health indicates that population segment between the age o 25 to 64 comprise more than 49%

of the total patients that these FQHCs serve.

Considering these statistics, another figure indicates that these FQHCs also play a vital role in

treating underserved people and the minorities.

Figure 2: Ratio of minority population served at community health centres

The racial minorities constitute 20.2% of the U.S population and 38% of the patients

serviced by the Community health centre patient population. The FQHCs serve people who are

200% below the poverty level as defined by the federal government. Such patients constitute

92.5% of the total patients served by FQHCs. Hispanic and uninsured patients constitute 34.9%

and 38.2% of the total number of patients served by FQHCs.

The author has concluded that though ACA has proposed taking many small steps to

improve the healthcare system, these small steps are synergistic in nature and will complement

each other. The impact of one measure will be experienced on other and thus a chain of events

taking place in an integrated healthcare system will allow the inclusion of maximum possible

population in the U.S. healthcare system. The health information technology (HIT) that the

government intends to leverage upon for making this system an integrated hub serving millions

of patients will help in achieving more than one objective. The payments of physicians and

other health service staff will also be increased as well as streamlined.

The author has described the potential advantages of ACA in detail. Nonetheless, there

remains a valid concern regarding the massive demand that government intends to generate

through this healthcare bill. The supply side of this system has yet not received much attention

as the number of physicians involved in this system will increase by manifold. To fulfil the

generated demand will require an advanced planning on part of healthcare facilities. The role of

state governments will also be significant in integrating the whole system. There is also an

implication of such increased spending regarding wasteful use of these increased funding from

federal government. The role of hospitals and healthcare centres in proactively anticipating

such waste will be key factor to efficient use of enhanced resources for healthcare.

Another area in which the Physician’s role as a manager will change is the process of

decision making and reaching judgments about the type of treatment to be offered to patients

(Oberlander, 2012). The replacement of individual payments with bundled payment has

necessitated more effective communication and teamwork amongst medical health

professionals, thus altering their management role in terms of the application of the ACA.

Furthermore, Physicians will also be required to play an important role in reducing the

administrative processes, thus improving the efficiency of medical care related services

(Kocher et al., 2010). Instead of slowing down the provision of medical care to the patients due

to administrative processes, the physicians may be required to manage the handling of such

operations. Hofer, Abraham and Moscovice (2011) observed that federal government set the

limit of deserving population as one that will be 133 percent below the federally decided level

of poverty. Valuable subsidies will be provided to the uninsured segments and this will increase

the demand for healthcare services tremendously. Through the ACA, the federal government

will try to increase the supply of primary care physicians. These primary care physicians are the

entry point for majority of the patients being admitted in the healthcare system.

Compensating Physicians under a new healthcare model:

Davis, Abrams and Stremikis (2011) have provided one illustration of the how the ACA

has aimed to provide medical care professionals the incentives to open up and accept the

changes offered by this act. Within a period from 2011-2015, the government will be offering

an investment of $1.5 billion. This investment will be used to provide scholarships and loan

forgiveness to all medical health professionals who practice in specific areas of medical care.

Davis et al (2011) has also indicated that the act intends to allow primary care services

to increase through offering incentives to medical care providers in this field. Offering 10%

bonuses to Physicians who are a part of Medicare, as well as providing bonuses to Medicare

entities that provide healthcare services to a higher number of patients will benefit from such

forms of reinforcement. A public hospital with revenues of $200,000 will therefore be provided

with a bonus of up to $16,000 on an annual basis for a period of five years. On a nonmonetary

level, the development in the level of competence of Physicians serves as an incentive to strive

to implement ACA (Kocher, et al., 2010).

Summary of Literature Review

The literature review presented above has been focusing on the analysis of the purpose

of the Affordable Care Act, its capability of fulfilling its purpose, as well as the implications on

medical care services and Physicians. The analysis of related secondary data suggests that ACA

offers some major benefits to healthcare providers, medical systems as well as patients. The

increased span of coverage of Medicare and Medicaid would facilitate medical care providers

the capabilities to proceed with providing quality services to a larger number of patients. The

access of increasing the number of people to insurance would eventually result in an increased

ability to visit the hospital and seek medical treatment. An effective and interactive summary of

the impact of Affordable Care Act has been presented by Price Waterhouse Coopers (PWC)

which uses variables of race, health status, marital status, language etc to identify the changes

occurring in the patients being served by Medicaid (refer to figure 2 in appendix).

There has been considerable research on the role of ACA in promoting the healthcare

system that not only promotes equity within the system but also effectively responds to the

needs of patients. The main emphasis of the government, through the adoption of CA has been

the paradigm shift in healthcare service delivery. The government also intends to change the

way that healthcare is perceived by the underserved segments of the society. Inclusion of

research based practices is also a focal point made in the commitment of funds. The main

emphasis of the regulating bodies and government will be ensuring the coordination of services

at all levels and all stages of the patient care. Monitoring and its role in patient care

management have increased through this act. By making the valuable knowledge regarding the

patient available to the physician, the system will optimally reduce number of visits and

readmissions.

However, there are certain limitations that reduce the effectiveness of the ACA in

promoting the expected usefulness of alterations in medical infrastructure. For this reason,

Physicians have speculated that the scope of application of the ACA and the flaws it carries can

potentially reduce its effectiveness. The review has also indicated the process of monitoring of

the application of the provisions of ACA, and the role Physicians can play in the

implementation phase as both a healthcare provider and manager. Furthermore, the penalties

associated with the failure to implement the ACA have also been explored. Lastly, the various

metrics that can be used for analyzing the effectiveness of the ACA have also been discussed.

Research Methodology

The research process will be based on quantitative approach, using primary data which

will be obtained from 30 Physicians (15 from Medicaid and 15 from Medicare) through a

survey. The management at Medicaid and Medicare hospital will be contacted. They will be

provided with the sample questionnaire to provide an idea about the scope of the study. Once

the management issues the permission for data collection, the questionnaires will be provided

to the physicians, requesting to be filled up in a week, which will be duly collected in the

specified time. Follow up will be conducted to obtain questionnaires from the respondents who

haven’t provided them in the first round of data collection. The participants will also be

contacted through email, requesting for the return of filled in survey as early as possible.

The questionnaire developed for the purpose of collection of primary data will consist

of 19 close ended questions and the responses will be provided on a 4 point Likert-type scale

(refer to the appendix). These questions will be related to the areas identified above (operations,

marketing and management of hospitals). The question will seek information from the

physicians about their perception of the ACA in terms of the nature for different types of

hospitals, primary care units and specialist services. The alterations needed in hospitals will

also be explored. Moreover, the level of information of patients from different socio-economic

groups regarding their understandings about the ACA will also be studied.

The literature review also indicates that there is an increased concern amongst the

scholars and practitioners of healthcare that utilization of such massive increased funds will be

an issue for the healthcare facilities. Capacity building and effective monitoring of progress still

remains an important discussion issue for scholars in healthcare research. The government and

ministry of health have tried to include maximum number of complementing elements in

healthcare delivery. The ACA is geared towards reforming the payment system of healthcare

along with achieving clinical integration and removal of disparities in the service delivery and

insurance.

The impact on the everyday operations, marketing, and management functionalities of

their healthcare units will also be included in the study. The everyday operations will comprise

of dealing with patients, providing the needed medical care, maintaining records of patients and

coordinating with other Physicians. The marketing function will include highlighting the need

to obtain primary care activities, emphasis on insurance and the implications it carries for

patients and Physicians. Lastly, the management area will be explored through questions

related to how the managerial role of Physicians has been altered due to the ACA. The role of

Physicians in managing the knowledge of patients about ACA and its related changes also

formulates a key area of management for healthcare providers.

The raw data obtained by the physicians will be analyzed using descriptive statistics

(frequencies, percentages) to identify the ratio of respondents across each response category.

Such descriptive statistics will provide an overview of the pattern of responses, providing an

idea about the overall perception of physicians. In addition to this, the response categories that

have obtained lowest score will also be a prime area of interest in terms of the perception of

medical care providers about ACA and its various implications.

The research will also include quantitative data available from secondary sources of

information such as financial analysis conducted by other researchers; forecast of financial

impact of ACA on hospital’s functioning etc. This financial information will provide the

researcher to gain insight into the implications of ACA on US hospitals from a managerial as

well as financial perspective. The available numerical data will also support the researcher in

gauging the level of financial implications the medical care centres have to deal with after the

implementation of ACA.

Findings

The analysis of survey results indicates that the physicians tend to vary in their perception

about the usefulness and implications of Affordable Care Act.

The first question was focusing on identifying the perception of physicians about ACA

treating different types of hospitals equally. It has been found that majority of the respondents

(90%) have disagreed with this notion, thus suggesting that ACA doesn’t uphold equal policies

for primary care units and specialists services. Only 10% of the respondents have considered

ACA to offer equal policies for primary and specialist services as shown in the following table.

Question 1: ACA treats different types of hospitals equally

q1

Frequency Percent Valid Percent Cumulative Percent

Valid Somewhat Agree 3 10.0 10.0 10.0

Somewhat Disagree 15 50.0 50.0 60.0

Strongly Disagree 12 40.0 40.0 100.0

Total 30 100.0 100.0

Question 2: ACA has equal policies for primary care units and specialists services

q2


Valid Strongly Agree 7 23.3 23.3 23.3

Somewhat Agree 20 66.7 66.7 90.0


Total 30 100.0 100.0

For question number 3, there were 94% respondents who have agreed that hospitals need

to implement major changes to comply with the policies of ACA.

Question 3: Hospitals need to implement major changes to comply with the policies of ACA

q3





Total 30 100.0 100.0

Another related issue in this regard is the alterations in the infrastructure of the hospitals,

as observed from the favourable responses generated from 90% of physicians included in the

survey.

Question 4: The infrastructure of hospital will need to be changed to effectively implement the

policies of ACA

q4






Total 30 100.0 100.0

Another significant change that can be deemed as a part of ACA implementation process

is the rise in workforce in healthcare sector. There were 90% respondents who have agreed with

the statement that the number of physicians will need to be increased to effectively implement

the policies of ACA. On the other hand, a minuscule ratio of physicians (10%) have negated the

necessity of increasing the number of healthcare providers as an effective tool of catering to the

needs of the increasing number of patients visiting healthcare facilities.

Question 5: The number of physicians will need to be increased to effectively implement the

policies of ACA

q5






Total 30 100.0 100.0

Question number 6 was related to the need of training to ensure that healthcare providers

at all levels (physicians and nurses) are enabled to adapt with the changes in the healthcare

delivery system. It has been found that 94% of physicians included in the study were in favour of

providing such training to physicians and nursing staff.

Question 6: Physician and nurses will have to be provided training to effectively implement the

policies of ACA

q6





Total 30 100.0 100.0

Another implication of ACA is the changes in the level of coordination among different

physicians and healthcare units. In order to effectively respond to the changes being triggered by

ACA, 94% of the respondents have agreed with the notion that improved level of coordination

needs to be established in the healthcare domain.

Question 7: Coordination between different physicians and healthcare units needs to be improved

to adjust with the changes required by ACA

q7






Total 30 100.0 100.0

The analysis of physician’s perception about the level of knowledge possessed by the

patients has also been a part of the study. It has been found that 74% of the respondents have

shown agreement with the statement that level of knowledge about ACA differs among patients

belonging to different socio-economic classes. However, 26% of the respondents have negated

this idea. Instead they have suggested that the socio-economic status of a patient can’t be used as

an indicator of level of understanding a person is likely to have about the nature and scope of

ACA.

Question 8: Level of knowledge about ACA differs among patients belonging to different socio-

economic classes

q8






Total 30 100.0 100.0

Another area explored in the survey was the presence of differences about the level of

understating patients have about ACA, suggesting that lower and middle class has greater degree

of information about the act. It was found that only 44% of respondents have agreed with the

statement. On the other hand, a significant ratio of respondents (56%) have indicated that no

notable difference tend to exist among the patients from lower/ middle and upper class in terms

of their level of awareness about ACA.

Question 9: Lower and middle class have higher level of information about ACA than upper

class

q9





Total 30 100.0 100.0

The respondents have also questioned about the differences in level of knowledge for

ACA due to age of patients. It has been found that age is deemed as a more accurate indicator of

level of understanding an individual has about ACA. A significant proportion of respondents

(84%) have indicated that patients in younger age group are more likely to have a greater degree

of knowledge about ACA and its implications on their ability to access healthcare services

through publicly owned healthcare centres. On the other hand older people may find it difficult

to comprehend the implications of ACA in the similar manner.

Question 10: Younger patients have more information about ACA than older patients

q10






Total 30 100.0 100.0

A major expected outcome of the implementation of ACA is the increasing number of

insured patients visiting the hospital. This increase can be attributed to the heightened focus on

improving the access to insurance and addressing the issue of underinsured individuals. An

interesting thing to note here is that all of the respondents included in the survey have agreed

with the notion that the number of insured individuals visiting the hospital will increase, thus

drawing a 100% agreement in this regard.

Question 11: Application of ACA will increase the number of insured patients visiting the

hospital

q11




Total 30 100.0 100.0

Question number 12 was focusing on changes in the number of uninsured patients

visiting hospitals. There were 97% of respondents who have agreed with the notion, while a

small percentage of 3% respondents have shown disagreement with the idea.

Question 12: Application of ACA will increase the number of uninsured patients visiting the

hospital

q12





Total 30 100.0 100.0

The management of operations at the hospitals are also likely to be adjusted according to

the requirements of ACA. In this context, the participants were asked if they perceived that the

hospitals will be required to adopt team based approach to adhere to ACA. It has been found that

97% of the respondents have shown agreement in this regard.

Question 13: Hospitals will be required to adopt team based approach to adhere to ACA

q13





Total 30 100.0 100.0

The marketing activities of the hospitals are also expected to be prone to changes due to

ACA. The participants have been questions in this context as well. One of the areas addressed in

the survey as related to the need to focus on increasing awareness about ACA through marketing

activities of the hospitals. The results indicate that 83% of the physicians have suggested that a

prime focus of hospital’s marketing activities will be on creation of awareness among the masses

about ACA.

Question 14: The marketing activities of the hospital need to focus on increasing awareness

about ACA

q14






Total 30 100.0 100.0

Another aspect of marketing process explored in the survey was related to offering

encouragement to the patients to purchase insurance and use exchanges for insurance. The results

depict that only 40% of the physicians have agreed with this role of marketing. On the other

hand, a significant number of physicians (60%) have indicated that encouraging the patients to

engage in behaviours such as purchase of insurance and usage of exchanges for insurance

doesn’t fall within the domain of responsibilities of healthcare service providers. Other institutes

(such as local government) have a greater degree of responsibility to ensure that individuals are

provided with adequate level of incentives to motivate favourable behaviour towards purchase of

insurance.

Question 15: The marketing campaign of hospitals should encourage patients to purchase

insurance and use exchanges for insurance

q15






Total 30 100.0 100.0

The participants were also enquired about the marketing function of the hospital serving

as a means of highlighting the application of ACA in providing healthcare services to the

patients visiting the hospital. There were 70% of the physicians who agreed that marketing

activities regulated at the hospital should also integrate this function as a part of marketing

process. However, 30% of the respondents considered such an activity outside the scope of

marketing function of the hospitals.

Question 16: The marketing function of hospital needs to highlight how the hospital is applying

ACA

q16






Total 30 100.0 100.0

In case of monitoring the implementation of ACA the respondents were asked about their

role as a part of the monitoring of the effectuation process of the act. As evident from the results

(refer to the appendix) a large number of respondents (90%) have provided favourable response

to the statement. There were a smaller proportion of physicians (10%) who have considered that

physicians would not be required to play a critical role during the process of implementation of

ACA. Since, the physicians are the critical part of delivery of healthcare services, the

implementation can’t be carried out without adequate support from them.

Question 17: Physicians will be required to monitor the implementation of ACA

q17






Total 30 100.0 100.0

Apart from monitoring the implementation of ACA policies, the physicians will also be

required to measure the degree of effectiveness of ACA in hospitals. This role necessitates the

adoption of responsibility of careful analysis of the hospital’s existing policies, the integration of

ACA policies and the identification of relevant tools to measure the degree of effective

application of the act in healthcare centres. The results obtained from the survey show that 97%

of the respondents have agreed with the statement, while only 3% of the respondents have

negated such notion.

Question 18: Physicians will be required to measure the degree of effectiveness of ACA in

hospitals

q18





Total 30 100.0 100.0

The survey also included a question about the changes following the complete

implementation of ACA in 2014, thus identifying the perception of the respondents in long term

context. It has been found that 94% of the respondents consider that full implementation of ACA

in 2014 will give rise to long term changes in the process of healthcare delivery to the patients.

Question 19: The role of physicians will change after the full implementation of ACA in 2014

q19





Total 30 100.0 100.0

The information generated from the respondents has provided insight into the impact of

Affordable Care Act on healthcare providers, patients, and hospitals as a whole. A significant

number of respondents have suggested that ACA emphasizes the primary care services,

offering support to the physicians in this domain. On the other hand, specialists are not able to

obtain the same level of emphasis. One probable reason for this difference in focus can be the

need to provide uninsured individuals access to primary health care services (Goodson, 2010).

The respondents have also indicated that the hospitals need to bring about some changes

in their infrastructure, means of handling patients, as well as the level of knowledge physicians,

nurses and specialists have about ACA. To ensure that the healthcare providers are able to have

adequate level of knowledge in this domain, the participants have also expressed the need to

devise training and orientation programs for the personnel. The hospitals may also need to

enable the physicians to be better able to coordinate with other healthcare provider, which

requires a shift from scattered healthcare service to a more cohesive form of healthcare (Shields

et al., 2011). In addition to this, the respondents have also suggested the necessary changes that

can help the physicians in meeting the expectations of increasing number of insured patients.

The survey questions have also investigated about the level of information that patients

from varied socio-economic background had about ACA. The respondents have indicated that

the patients seem to have some level of information about ACA across different socio-

economic classes. An additional element that the respondents have presented is the effect of age

on knowledge of ACA. It has been stated that younger patients seemed to have more

knowledge about the act and its impact on the healthcare delivery than older patients. Leff and

Novak (2011) have illustrated how older patients may find it difficult to handle information

about changes in healthcare services. Along with that, keeping track of the changing nature of

healthcare delivery system in US may also be an intricate task for the older patients.

The respondents have also been inquired about the role of ACA in altering the everyday

operations of the hospital. The interviewees have claimed that the effect of ACA will be more

profound than initially anticipated. The hospitals will be required to make adjustments to

respond to the increasing number of insured and documented patients. At the same time, the

undocumented workers who have been treated in the past will not be able to receive the same

level of medical care due to the changes in everyday operations. Moreover, a highly

coordinated and team based approach will need to be adopted as the payment will be issued for

team rather than individual physicians (Hosseini, 2012).

In terms of marketing activities of the hospital, the respondents have stated that the

healthcare providers would be required to raise the level of awareness of patients about the

various policies related to ACA. The marketing efforts may not need to take into consideration

the notion of encouraging patients to seek insurance, use exchanges for insurance and gain

access to better quality and scope of healthcare services. However, such endeavours will need

to highlight the steps the hospital has taken or intends to take to implement the provisions of

ACA in an effective manner.

One of the major areas where ACA will have an impact is the management activities of

the physicians and hospital (Kocher & Sahni, 2010). As noted by the respondents, the physician

will be required to monitor the effective implementation of ACA, as well as gauge its level of

effectiveness on the primary and specialist healthcare services. Another area of managerial

responsibility will be providing orientation and training to the nursing staff and physicians in

order to ensure effective application of the provisions of ACA. In order to maintain a high level

of revenue as well as provide quality service to the rising number of insured patients, the

physicians will be required to manage their work responsibilities in an effective manner. The

shifting role of physician from an individual medical care provider to the part of a medical team

is also one of the implications of ACA and management responsibilities of healthcare providers

as noted by the respondents.

As far as educating the patients about the provisions of Affordable Care Act is

concerned, the physicians as a healthcare provider have an additional responsibility to provide

the related knowledge to the patients. The interviewees have asserted that the role of physicians

as only providing medical treatment will be altered after the full implementation of ACA in

2014.

Summary

The Affordable Care Act will on one hand provide physicians with an opportunity to

gain access to scholarships and bonuses. On the other hand, the additional cost of adapting to

the needs of increasing number of patients will exert financial pressure on the hospitals. The

current infrastructure facilities will be required to be expanded to ensure that the healthcare

needs of the increased number of insured patients are met effectively. As a part of the

operations of the hospital, the physician will also be required to bring alterations in the role,

expanding it into the domains of management and training.

The primary health care service providers, specialists, physicians dealing with children

and doctors handling patients with chronic illnesses will have to deal with different operational

implications. The bundled payment system is more likely to have an effect on the physicians

taking care of patients dealing with more than a singular chronic illness. Similarly, the

physicians operating in the domain of primary care services will be required to handle a grater

workload as well as maintain balance between number of patients and the quality of healthcare

services offered to those patients.

Recommendations

Based on the information obtained from physicians and the review pertinent literature about

the possible effects of Affordable Care Act on the operational and financial position of the

hospital and staff, the following recommendations have been put forward:

Offering training to physicians and nursing staff: The training sessions will allow the

physicians to build up adequate level of competence to handle the rising demand of medical

care service. The training will also provide the physicians with an outline of the various

provisions of ACA, thus enabling them to understand them and communicate about other

physician and patients accordingly. Another area of training that can be deemed as a necessity

due to ACA is related to maintaining coordination and communication among various

departments and specialists.

A second recommendation in this regard is to devise a clear plan of action to implement

ACA within hospital, identifying the milestones and various phases of implementation. The

application of ACA will be an intricate task, thus clarity of strategy is needed to handle the

implementation effectively. The hospital management will also be required to adopt appropriate

change management tools to ensure that the primary healthcare providers, specialists and

nursing staff are willing to embrace the changes associated with the implementation of ACA.

Lastly, the hospitals will be required to build closer ties with the internal and stakeholders

including employees, patients, insurance providers, local government and federal government.

It will not only help the hospitals in gaining necessary support to implement ACA, but will also

allow them to play a key role in monitoring the implementation process as well as measure the

degree of effectiveness of ACA in improving the access to and quality of medical care.

Conclusion:

Affordable care Act has been proposed as a means of handling the increasing cost of

gaining access to quality healthcare facilities. There are certain limitations evident in the

successful application of ACA across various public hospitals in US. However, the act also has

the potential to improve the chances of US residents in gaining access to healthcare facilities as

well as lowering the cost of healthcare incurred by individuals. It can be concluded that the

implementation of ACA brings along challenges as well as possibilities for improving the

healthcare system in US. To improve the current medical care system, physicians, hospital

management, hospital boards and various levels of government need to integrate their efforts.

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Appendix

Figure 1: Criteria for Determining Penalty for Businesses

Mulvey (2013, p. 5)

Figure 2: Population being served by Medicaid

Source: (PWC, 2013)

Questionnaire

Question Strongly Agree

Somewhat Agree

SomewhatDisagree

Strongly Disagree

1. ACA treats different types of hospitals equally

2. ACA has equal policies for primary care units and specialists services

3. Hospitals need to implement major changes to comply with the policies of ACA

4. The infrastructure of hospital will need to be changed to effectively implement the policies of ACA

5. The number of physicians will need to be increased to effectively implement the policies of ACA

6. Physician and nurses will have to be provided training to effectively implement the policies of ACA

7. Coordination between different physicians and healthcare units needs to be improved to adjust with the changes required by ACA

8. Level of knowledge about ACA differs among patients belonging to different socio-economic classes

9. Lower and middle class have higher level of information about ACA than upper class.

10. Younger patients have more information about ACA than older patients

11. Application of ACA will increase the number of insured patients visiting the hospital

12. Application of ACA will increase the number of uninsured patients visiting

the hospital

13. Hospitals will be required to adopt team based approach to adhere to ACA

14. The marketing activities of the hospital need to focus on increasing awareness about ACA

15. The marketing campaign of hospitals should encourage patients to purchase insurance and use exchanges for insurance

16. The marketing function of hospital needs to highlight how the hospital is applying ACA

17. Physicians will be required to monitor the implementation of ACA

18. Physicians will be required to measure the degree of effectiveness of ACA in hospitals

19. The role of physicians will change after the full implementation of ACA in 2014

afforable care act final

Documents

provisions of aca

implications of aca

affordable care act

perception of physicians

nature of aca

enforcement of aca

quality healthcare

compensating physicians