HUP adjusts to implementation of Affordable Care Act


Hospitals around the country will have to re-think how the system is structured to cut costs




Barack Obama’s re-election assures that the Affordable Care Act is here to stay. But, what does this mean for the Hospital of the University of Pennsylvania?

According to Daniel Polsky, Perelman School of Medicine and health care management professor, not too much will change for HUP in terms of the amount of uncompensated care HUP is already providing to uninsured patients.

But it will impact how hospitals operate, Polsky said.

Health care management professor Arnold Rosoff agreed. “We have a very ‘fat’ system, and as wonderful as medical leaders like HUP are, they are part of the fat — or very likely to be seen as such ­­— whether they are or not.”

“As a nation, we must take all manner of steps, some of them extreme, to cut the fat out of the system — hopefully without hurting technical quality or humanity of care but, at the same time, increasing access,” as the ACA aims to do, he said.

With new Medicare standards, HUP will be able to provide more care to more patients, but they need additional funding to provide this care, Polsky added.

Hospitals will get lower reimbursements from Medicare and ultimately lose money, University of Pennsylvania Health Systems Chief Nurse Executive Victoria Rich said.

“Money that we get will decrease because the money that a hospital saves by providing preventative care instead of emergency care will now go to those who were previously uninsured,” Rich continued.

Prior to the ACA, a hospital was paid to treat patients when they’re already sick. Now, preventative care is more of a focus. Hospitals are realizing that they must reallocate the reimbursements and become more cost effective.

“There is an ‘iron triangle’ made up of quality, access and cost,” Rosoff said. “We need to keep those three things in balance and it’s extremely hard — some even say impossible.” This is why hospitals are looking for new ways to design care accordingly.

“With the way ACA will be rolled out, we have to be in the business of keeping you well instead of treating you when you’re sick,” Rich said.

This has led HUP to the idea of team intelligence — an entirely new model of care, she added.

Under this model, health care professionals will be asked to “articulate, communicate and collaborate with each other so they can work together to care for one patient,” Rich said.

“It is no longer just the doctor talking to the patient,” Rich said. “It’s the nurse, the pharmacist and the patient’s family who work together to plan the care for the patient so that he will not need to return to the hospital.”

The increase of access that the ACA provides has solved some problems but also created new ones, such as a shortage of primary care doctors as opposed to specialized doctors to provide care for the newly insured.

University of Pennsylvania Health System spokesperson Susan Phillips added, “as more individuals have insurance coverage, there will be an increased demand for physicians, especially those who practice primary care medicine and the ACA will only exacerbate the shortage.”

The School of Nursing has received grants from the state and federal governments to educate over 1,000 advanced practiced registered nurses to help provide primary care to the additional 32 million now eligible for insurance.

Polsky believes that the ACA fails to address the rise in health care costs, which creates uncertainty for health care professionals and Americans seeking care.

“In the past 40 to 50 years, the amount of money spent in the health care sector grows more than income growth, so the expectation is that this will continue and this will eat up more of our budget whether it is the government’s or a family’s,” he said.

Health care management professor Mark Pauly said that the ACA directly affects public insurance spending.

“Rising health care costs for public insurance either add to the taxes Americans must pay or to the deficit,” he said. Either way, someone has to pay.

Rich added that the health care system under the ACA does not provide for standardization across the U.S. of how health care professionals should care for patients. Each state can decide for itself if it wants to be part of the ACA, which creates inconsistency of care.

“The Affordable Care Act begins to cover the bases, but it does not cover all the needs of our patients because it takes money from one group and gives it to another,” Rich said.

This article has been revised to accurately indicate that HUP does provide a large amount of care to uninsured patients.

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