Guthrie CEO gives health care presentation
By Amanda Renko, The Daily Review, Towanda, Pa. | |
McClatchy-Tribune Information Services |
A presentation by Dr.
About 40 people joined Scopelliti in Guthrie's
During the presentation, Scopelliti explained the changes made to health care by the act, answered audience questions and addressed how Guthrie has prepared and responded to the reforms.
The act, signed into law in 2010, made provision by subsequent legislation to expand health insurance coverage, lower health care's cost to society and improve the quality of care over a several-year period.
The insurance exchanges introduced last year were designed to expand access to uninsured Americans, including the working poor, those ineligible to receive insurance through their employers, and younger and healthier people, Scopelliti said.
94 percent
Officials aim to have 94 percent of legal U.S. residents insured by 2019. About 2.5 million people had enrolled for health insurance coverage through the exchanges as of Friday, short of the 7 million-person target officials had hoped for by March, he said.
The legislation also removed co-pays for preventive services, prohibited annual and lifetime benefit caps and exclusion due to pre-existing conditions and expanded
The act also instituted financial penalties for citizens without insurance and for employers of a certain size that didn't offer it. However, those penalties appear to be on hold, Scopelliti said.
Furthermore, as the exchanges fail to attract younger and healthier citizens, the system may become economically challenged. "This challenge will be exacerbated as the year goes on," Scopelliti said.
Reduced costs
The act also has several measures designed to reduce costs, Scopelliti said. A website designed to allow patients to compare health systems for cost and quality, hospitalcompare.hhs.gov, launched in 2011. However, "very few people use it," he said.
The law also includes a pay-for-performance model where health systems continue to receive payment on a per-admission basis. However, 2 percent of the payment is withheld for the health system to "earn back" by meeting benchmarks for quality, cost and patient satisfaction, Scopelliti said.
The measure establishes financial penalties for re-admitted patients and for the occurrence of adverse, serious and usually preventable instances known as "never events," such as surgery performed on the wrong part or the wrong patient.
The measures offer health systems a financial incentive to keep patients healthy and encourages more coordinated care, including increased reliance on outpatient visits, home-based systems and telemedicine, Scopelliti said.
The value-based purchasing provisions promote transparency and shorter hospital stays, Scopelliti said. However, health systems will also need to invest in sophisticated information technology infrastructure to support the move toward coordinated care. Guthrie has already invested over
Further financial incentives come with a program where designated health systems, known as Accountable Care Organizations, receive bonus payments to improve quality and reduce costs.
The program stems from a 10-system pilot program conducted by the
Under the ACO program, systems are responsible for the quality and care of a given population in their service region, Scopelliti said. The program is meant to encourage collaboration to improve quality and efficiency, he said.
However, with more of the financial incentive coming on the back end, health systems experience more financial risk under the act, Scopelliti said. And bonuses aren't necessarily enough -- out of 32 "pioneer" ACOs that volunteered to pilot the program, nine have moved out of the model by its second year, Scopelliti said. Quality improved in almost all instances, but very few ACOs made a profit, he said.
In addition to upgrading its technology infrastructure, Guthrie has made several preparations and organizational changes in response to the Affordable Care Act, Scopelliti said.
While the law provides rewards and penalties, "how we, as a business, respond to those is up to us," he said.
The changes center around reducing inefficiency and smoothing out the process of care. In recent years, Guthrie has expanded its geographic coverage and clinical services, recently building six new primary care offices to handle an expected increase in insured patients.
Guthrie officials have also placed a focus on patient satisfaction and are utilizing the Lean Six Sigma process of eliminating organizational inefficiencies, Scopelliti said.
As large-scale health systems become more common, Guthrie's challenge will be continuing to remain different and unique from other systems, Scopelliti said.
While a health system's size and scope will be critical in making the changes, Scopelliti is confident Guthrie will maintain its unique culture, history and individual approach to patient care. "Health care is really personal," he said. "It's one-on-one."
While the legislation has been passed, converting it into regulations and implementing them will take years, and expanding coverage will likely increase costs and reduce access at least temporarily, Scopelliti said.
While Scopelliti doesn't believe the basic components of the act will go away, he thinks more changes are likely to come. "I don't believe this is the final stop," he said.
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