NORMAN — With some provisions of the federal health care law set to go into effect Jan. 1, 2014, some are wondering what changes can be expected locally.
David D. Whitaker, Norman Regional Health System president and CEO, said the Patient Protection and Affordable Care Act (PPACA) will see both small and large changes for Oklahoma residents.
A large factor in those changes will be determined on what types of pre-existing financial coverage — if any — each individual carries, Whitaker said.
“Private, commercially insured patients should be asking their employers or insurance provider about changes to their health plan coverage,” Whitaker said. “Medicare patients will see more emphasis on outpatient services. Medicaid patients may or may not see major changes, depending on the decision by the state to participate or not participate in Medicaid expansion.
“And uninsured patients should be preparing for a newly created health insurance exchange that will offer low-cost options supported by federal tax credits. Patients also need to be discussing continuing care option with their primary care provider as the patient/doctor relationship could change ...”
As for a change in care provided at Norman Regional’s campuses throughout Norman, Moore, Blanchard, Newcastle and Oklahoma City, Whitaker said a shift in operations is anticipated.
“The old axiom of ‘doing more with less’ will no longer ensure survival,” he said. “Long-term survival will now depend on ‘doing better with less.’”
Whitaker said Norman Regional will focus on three major operational changes: reducing operating costs, improving operational efficiency and clinical outcomes, and improving the patient experience.
Operational changes will effect Norman Regional employees as well, Whitaker said. Employees will be expected to be flexible and innovative in delivering patient care.
“One of the changes to the Medicare program’s reimbursement system is a defined shift from paying providers for improved patient care outcomes rather than quantity of care provided,” he said. “Year 1 of the Value Based Purchasing (VBP) reimbursement system will result in all hospitals being at financial risk for part of each patient’s care, based on specific Quality Core Measures and the patients’ experience while hospitalized as an inpatient.
“During Year 1 of the VBP system, Norman Regional will be at risk of losing an estimated $1 million of reimbursement if target quality outcomes and patient experience outcomes are not met. The at-risk dollar amount increases annually for the next seven years.”
Whitaker said PPACA implementation stretches to 2020, and there is still much to be learned from both a patient and provider perspective.