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How the Affordable Care Act Will Help on a National Scale

While Americans worry about the effects of the Affordable Care Act on their personal lives—will their employer provide health insurance? will they have to pay for it themselves?—many Americans may not be aware of the benefits the Act will have for the nation as a whole.

Adding to the Federal Budget

According to the Congressional Budget Office, the Affordable Care Act will result in reducing the federal budget anywhere from $84 billion to $210 billion between 2012 to 2021. This figure depends on how many states choose not to expand Medicare.

The Act will also assist Medicare by reducing the growth of Medicare payment rates for services, imposing an excise tax on insurance plans with relatively high premiums; and instituting changes to the federal tax code, Medicare, Medicaid, and other programs. This may eventually extend the solvency of Medicare by 8 years.

Improving Patient Care

The Affordable Care Act provides encouragements for health care providers who treat Medicare patients to form ACOs: Accountable Care Organizations. These are groups of doctors, hospitals, and other health care providers who form networks of coordinated medical care for Medicare patients. The goal is to reduce inefficient spending by making sure patients get the right care at the right time, avoiding unnecessary duplication of services, and preventing medical errors.

Accountable Care Organizations have demonstrated an ability to reduce emergency room visits by high-risk patients. This in turn reduces the amount of money Medicare has to spend. Coordinating medical treatment is another way that these groups are saving money, in part by avoiding unnecessary or repetitive treatment. The government expects Accountable Care Organizations to save Medicare between $1 – $2 billion during its first four years.

These organizations are reimbursed for specific items and medical services, but they also benefit by saving Medicare money because they will receive a share of those savings. A benchmark will be calculated based on the Accountable Care Organization’s history of expenditures, and the group will then get a percentage of any savings.

The Accountable Care Organization program also provides for bonuses if hospitals and doctors show that they are improving or maintaining the quality of care. At the end of each year, Medicare will assess an group’s quality and financial performance based on a population’s use of primary care services.

New Jobs in Healthcare

Some Accountable Care Organizations are creating new jobs in the form of patient coordinators. These employees are responsible for tracking and maintaining the health of elderly and disabled patients. Some hospitals prefer that patients communicate with these coordinators instead of the patients’ physicians, because physicians often recommend unnecessary visits to the emergency room.

New York’s Mount Sinai Hospital has even instituted a computerized monitoring program. A computer program mines medical claims data and identify patients who are at highest risk to be admitted to the hospital. Care coordinators work with these high risk patients to make sure they get their prescriptions filled, take their medications on time, and get to their doctors’ appointments. These coordinators also help patients monitor themselves, such as weighing themselves daily or checking insulin.

Patients must be informed if their provider is part of an Accountable Care Organization, and must consent to having their information shared.