Healthcare Ecosystems Task 2
Running head: HEALTHCARE ECOSYSTEMS TASK 2
Healthcare Ecosystems Influence by Government Regulations, Legislation,
And Accreditation Standards
Iona R. Heffley
Western Governors University
1
HEALTHCARE ECOSYSTEMS TASK 2
2
Healthcare Ecosystems Influence by Government Regulations, Legislation,
And Accreditation Standards
Medicare is a national government-sponsored insurance program in the United States. Created by Congress in 1965, under President Lyndon B. Johnson, Medicare guarantees access to health insurance for Americans that are aged 65 and over and younger people with disabilities. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States (Torio & Andrews, 2013).
Medicare is a single-payer health care program, meaning that a segment of the population has its resources pooled into a fund that pays medical fees.
The continuing efforts of government payers to contain hospital costs has been a concern to hospitals that serving publicly insured patients may affect their ability to manage their revenue cycle successfully (Rauscher & Wheeler, 2010). This paper analyzes the impact of Medicare on the economics of healthcare.
Medicare’s Impact on Today’s Healthcare Ecosystem
Medicare has four parts: Part A is Hospital Insurance, covering inpatient hospital stays, hospice, home health care and skilled nursing facilities. There is no premium, but there are some copayments and a yearly deductible. Part B is Medical Insurance, covering doctor services, outpatient care and some preventive services, among others. This is optional and there is a monthly premium and an annual deductible. Part C refers to two types of health plans. One is branded as “Medicare Advantage”, where participants can choose to receive Medicare Parts A and B through an approved private insurance company under Part C. The other health plan is “Medigap”, a type of
Healthcare Ecosystems Influence by Government Regulations, Legislation,
And Accreditation Standards
Iona R. Heffley
Western Governors University
1
HEALTHCARE ECOSYSTEMS TASK 2
2
Healthcare Ecosystems Influence by Government Regulations, Legislation,
And Accreditation Standards
Medicare is a national government-sponsored insurance program in the United States. Created by Congress in 1965, under President Lyndon B. Johnson, Medicare guarantees access to health insurance for Americans that are aged 65 and over and younger people with disabilities. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States (Torio & Andrews, 2013).
Medicare is a single-payer health care program, meaning that a segment of the population has its resources pooled into a fund that pays medical fees.
The continuing efforts of government payers to contain hospital costs has been a concern to hospitals that serving publicly insured patients may affect their ability to manage their revenue cycle successfully (Rauscher & Wheeler, 2010). This paper analyzes the impact of Medicare on the economics of healthcare.
Medicare’s Impact on Today’s Healthcare Ecosystem
Medicare has four parts: Part A is Hospital Insurance, covering inpatient hospital stays, hospice, home health care and skilled nursing facilities. There is no premium, but there are some copayments and a yearly deductible. Part B is Medical Insurance, covering doctor services, outpatient care and some preventive services, among others. This is optional and there is a monthly premium and an annual deductible. Part C refers to two types of health plans. One is branded as “Medicare Advantage”, where participants can choose to receive Medicare Parts A and B through an approved private insurance company under Part C. The other health plan is “Medigap”, a type of
References: Budget of the United States Government. (2009). Updated Summary Tables, May, 2009, Budget of the United States Government, Fiscal Year 2010 Burning Glass Technologies. (2012). A Growing Jobs Sector: Health Informatics. Boston: Jobs for the Future hospital and critial access hospital conditions of participation. Final rule. Federal Register, 77(95), 29034-76. Centers for Medicare & Medicaid Services (CMS). (2013, November 27). Changes for Calendar Year 2014 Physician Quality Programs and the Value Based Payment Modifier Forbes.com. Retrieved 8 17, 2014, from http://www.forbes.com/sites/brucejapsen/2013/08/23/ u-s-says-more-doctors-accept-medicare-patients-access-excellent/ Rauscher, S., & Wheeler, J. R. (2010). Hospital Revenue Cycle Management and Payer Mix: Do Medicare and Medicaid Undermine Hospitals ' Ability to Generate and Collect Patient Care Torio, C. M., & Andrews, R. M. (2013, August). National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011