AMT2 Task 3

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School

Western Governors University *

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AMT2

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Health Science

Date

Feb 20, 2024

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docx

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Uploaded by kawrig0946

1 Healthcare Trends, Impacts and Legislation Kelly Wright Western Governors University Ashley Tennessee February 14, 2024

2 A. Trends One emerging trend in the healthcare industry that could potentially impact Trinity Community Hospital’s ability to deliver care is the problematic payment distribution from Medicare plans. As stated by the American Medical Association, “Even before rampant inflation and an epidemic, physicians were facing an unsustainable trend. When adjusted for inflation, Medicare physician payment already has effectively declined 26 percent from 2001 to 2023 before additional inflation and these cuts are factored in. Additionally, physicians saw a 2 percent payment reduction for 2023. Physicians are one of the only providers without an automatic increase to account for inflation” (American Medical Association, 2023). Not only have Medicare payments failed to keep up with national inflation rates, but payments have also been unacceptably slow to be processed and a staggering number of claims have been outright denied with little to no explanation leaving the burden of costs on the hospital, provider and patient. Another trend in health care that could affect Trinity's ability to deliver quality care is the prevalence of health care worker burnout. Even prior to the COVID-19 pandemic, healthcare workers were saddled with long work hours, staff shortages, and high patient loads which impacted their physical and mental health. The pandemic exacerbated these symptoms and currently more than 46% of all health care providers report feeling burned out, up from 38% in 2018 ( Health Workers Face a Mental Health Crisis , 2023). Study after study has confirmed that provider and professional burnout can lead to decreased patient satisfaction, low quality of life, and increased medical errors. “The effects of burnout can be far-reaching, adversely impacting both patients and healthcare professionals . . . It can also lead to increased absenteeism, reduced

3 productivity, physical and mental health problems, poor social relationships, and reduced job satisfaction among healthcare professionals” (Razai et al., 2023). B. Impacts The impact that Medicare payment has on Trinity is that physicians are less likely to stay under contract with Medicare plans if they are not being paid for the services they provide to patients. If Trinity is expecting to increase services across orthopedic, oncology, and cardiac specialties, physicians will need to know that they will be paid appropriately for their services. As Trinity currently does not have any oncologist on staff, it may be difficult to provide the specialty to the community if physicians prefer a competing hospital given a more diverse payer mix. Having to turn patients away given a lack of providers will directly impact the five-year strategic plan for expansion into 3 new specialties and will impact community health overall. Provider and professional burnout impacts Trinity because burnout can lead to job dissatisfaction and high turnover rates, as well as impact patient satisfaction and health outcomes. If Trinity is not able to manage burnout of the current staff, they may be more likely to leave for a job at a competing hospital which would make it difficult to serve the growing needs of the community where staff shortage is already an issue. Burnout could also impact the quality of care that a patient receives, for example, if a nurse is attending to more patients than is reasonable, mistakes could be made in medicine administration which could lead to serious medical consequences, including death. This would lead to decreased trust in Trinity from the community. Provider burnout could also make it difficult to retain specialists, which would also directly impact the five-year strategic expansion plan and the community’s overall health would be impacted since less patients would be able to be seen. C. Legislation

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4 To address the Medicare payment trend, Congress needs to pass a bill that stipulates that Medicare payments must rise with national inflation, and said increase must be maintained at no less than 1% of the current inflation rate. For example, if the inflation rates for 2023 were at 3%, Medicare payments must also increase by at least 2%. Additionally, if inflation in 2024 increases to 5%, Medicare payments must increase by 4%. The purpose of this bill is to ensure that not only are physicians and hospitals getting paid appropriately, but that their pay is also in accordance with market trends. If deflation occurs, Medicare payments can also be adjusted accordingly. Along with accounting for inflation, this new bill will stipulate the length of time in which Medicare has to repay hospitals and providers, with no more than 180 days being able to lapse before full or partial payment is required to the provider. If more time is necessary to process a claim, Medicare may file an application for extension with the appropriate American Medical Association committee for consideration. This new bill will also stipulate that failure to pay on time, or file an extension request, will result in additional fines for lack of payment. To address health care worker burnout, a new federal law will be passed mandating that every health care worker is guaranteed at least 15 days of paid time off per year, and for every additional 10 hours of overtime that is recorded, an additional PTO day will be granted. Workers will be mandated to utilize their time off and PTO days will not be able to be rolled over from one year to the next. If by Q4 of a given year a worker has not used at least 75% of their PTO, they will be assigned days off. Employers will also be mandated to provide mental health services, such as a subscription to Calm or BetterHelp, as part of their employee benefits package. Any employer found in violation of any of these new laws will be fined no more than $150.00 per violation, per employee.

5 References American Medical Association. (2023, September 11). Medicare physician payments need overhaul STAT . https://www.ama-assn.org/press-center/press-releases/medicare- physician-payments-need-overhaul-stat Health Workers Face a Mental Health Crisis . (2023, October 24). cdc.gov. Retrieved February 14, 2024, from https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html Razai, M. S., Kooner, P., & Majeed, A. (2023). Strategies and Interventions to Improve Healthcare Professionals’ Well-Being and Reduce Burnout. Journal of Primary Care & Community Health , 14 , 215013192311786. https://doi.org/10.1177/21501319231178641

AMT2 Task 3

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