U.S. Healthcare Ecosystem

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U.S. Healthcare Ecosystem
2014-01-30 23:36:58
Health Informatics
02-2014,Healthcare Ecosystems,Healthcare Delivery System,Chapter 02
Federal mandates that significantly shaped healthcare from 1935 to 2010.
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  1. Patient Protection and Affordable Care Act of 2010 (ACA/Obamacare)
    • Overhaul to the Medicare / Medicaid system
    • Improve care
    • Control costs
    • Created Healthcare Exchanges & CO-OPs for uninsured to select a plan of coverage
    • Added tax penalties for uninsured non-participants
  2. American Recovery and Reinvestment Act of 2009 (ARRA)
    • Stimulate economic recovery by adopting IT in healthcare
    • EHR (Electronic Health Record) - meaningful use
    • HITECH - repayment for technical education
    • Extended HIPAA to include privacy protections for EHR
  3. Omnibus Budget Reconciliation Act of 1990
    Requires Peer Review Organizations (PROs) to report action taken against physicians to state medical boards and licensing agencies
  4. Healthcare Quality Improvement Act of 1986
    • Established National Practitioner Data Bank (NPDB) for providers with actions filed against them
    • Established some immunity for some legal action against practitioners involved in peer review
  5. Public Law 92–603 of 1972
    • Utilization Review (UR) established
    • UR must prove Medicare treatment medically necessary
    • Established Professional Standards Review (PSRO)
  6. Omnibus Budget Reconciliation Act of 1985
    • Deny reimbursement for substandard care through Medicare/Medicaid
    • Changed HCFA to CMS (Center for Medicare/Medicaid services)
  7. Utilization Review Act
    • Added fraud and abuse regulations to Medicare / Medicaid
    • Created continued stay review for inpatients
  8. Public Law 89-97 of 1965
    • Amendments to the Social Security act of 1965
    • Changed reimbursement to curb Medicare / Medicaid spending
  9. Tax Equity & Fiscal Responsibility Act of 1982 (TEFRA)
    • Extensive changes to Medicare
    • Implemented PPS (Prospective Payment System): reimbursement schedule for all procedures
  10. Hill-Burton / Hospital Construction Act of 1946
    • Built new hospitals
    • Modernized existing hosptitals
    • Created a construction boom in the 1950's