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PPACA And Amcs: A Case Study

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PPACA And Amcs: A Case Study
The PPACA and AMCs
Implications of the Patient Protection and Affordable Care Act on Academic Medical Centers

Stewart Clark

University of Arkansas for Medical Sciences

Abstract

The Patient Protection and Affordable Care Act’s holistic implications on Academic Medical Centers (AMCs) are uncertain. However, projections can be made for how the PPACA will affect the clinical departments of a hospital and how legislation will impact subsidized payments to AMCs. Based on figures from the Department of Anesthesiology at UAMS, clinical departments will experience a surplus due to the diminishing population of self-pay patients. The debate over the shifts in volume comprises of two theories. …show more content…
The only 10 months of information was provided, but was then weighted to cover a full year. The University of Arkansas is a hospital of last resorts and the academic medical center for the state of Arkansas. The projections for this department will translate into rough projections for the hospital as a whole (Habenicht, 2013). For each unit of anesthesia Medicaid pays $20.67 of the charged amount of $80. The amount paid by Medicaid is statistically significantly lower than the amount paid by Blue Cross at $38.66/unit, commercial insurance at $44.47/unit, workers compensation at $33.58/unit, and PPOs at $37.32/unit. However, the rate for guarantor, or self-pay, is a minuscule $5.74 with a collection rate of only 7.18% (Habenicht, 2013). These figures represent the uninsured portion of the department of Anesthesiology’s payer mix. Despite the low payments by Medicare, $20.67 is a statistically significant increase from $5.74 paid by the average uninsured patient. In order to project the impact of the PPACA on the payer mix, and the overall effect on the finances of the department, this analysis will operate on four likely assumptions. The first assumption is that Medicaid Enhanced programs will pay $20 per unit of anesthesia. The second assumption is that $15 additional dollars per …show more content…
Friedman, M. (2013, October 7). Hospitals Worried About Impact of Insurance Exchanges. Arkansas Business. Retrieved November 24, 2013, from http://www.arkansasbusiness.com/article/95011/hospitals-worried-about-impact-of-insurance-exchanges?page=all
8. Gruber, J. (n.d.). The Impacts of the ACA: How Reasonable Are The Projections?. economics.mit.edu. Retrieved November 20, 2013, from http://economics.mit.edu/files/6829
9. Habenicht, Coleen. Personal Interview. 20 Nov. 2013
10. Hermer, L. (2013, September 1). PRIVATE HEALTH INSURANCE IN THE UNITED STATES: A PROPOSAL FOR A MORE FUNCTIONAL SYSTEM. law.uh.edu. Retrieved September 1, 2013, from www.law.uh.edu/hjhlp/Issues%5CVol_61%5CHermer.pdf
11. Herman, B. (2012, April 6). 12 Revenue Pitfalls for Academic Medical Centers. Becker 's Hospital Review. Retrieved November 24, 2013, from http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/12-revenue-pitfalls-for-academic-medical-centers.html
12. Kastor, J. (2012, February 17). Accountable Care Organizations at Academic Medical Centers. The New England Journal of Medicine. Retrieved November 24, 2013, from
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