Scenario: A family practice that serves over 4,500 patients is owned by three br

Question

Scenario:

A family practice that serves over 4,500 patients is owned by three brothers, all general practitioner medical doctors who have been closely watching how the new Patient Protection and Affordable Care Act (ACA or “Obamacare”) is developing, especially with the ongoing changes to the eligibilities of coverage for patients and reimbursements that now require their facility to change its systems and processes for compliance.

As a healthcare consultant, you have been retained by the family practice to perform a thorough audit and analysis of the facility, including its systems, processes, and procedures, with an emphasis on record keeping and coding/billing practices.

You have also spent some time with the owners of the family practice discussing what the future holds regarding the types of treatments, demographics of patients, and the effect of technology on the methodologies of patient treatment. Within this context, the client asks you to provide the following:

Questions:

When comparing the overall health care system in America, how does it compare to just 40

years ago?

Provide some examples of what specifically is critical for the healthcare organization to consider regarding how treatments are performed on patients.

What technological advancements do you predict in health care in the next 15 years, especially those that can be opportunities for a family medical clinic scenario?

What are the regulatory agency changes coming in the near future?

What are your predictions for the success of the ACA, especially in the next 5 years?

Explanation / Answer

*Health care system in America 40 years ago,most doctors were still independent and compensated through fee-for-service.
By mid 1980 Health maintenance organizations(HMO) began to dominate both the organizations of health care and reimbursement to physicians.
In 1990s HMOs and their varieties would revolutionalize the organization of health care in U.S and controversy among recipients of healthcare as well as doctors,who came to find less control of their practice.
Fee-for-service began to fade and prepaid health care has been focused by corporations.
world wide web in 1990s added to the health information.computer communications advancements also allowed for diagnosis and treatment.

*Examples of health care organizations to consider regarding how treatments are performed which are critical are-
-improvig health care Quality
-improve the patient experience of care
-improve health of population

*Technological advancement to predict for next 15 years
-Regenerative medicine providing replacement or repair of some types of damaged tissue and better management of certain diseases such as diabetes.
-many new pharmaceuticals and vaccines on biotechnological knowledge
-extensive screening for multiple genetic risk factors for common diseases
-new nutraceuticals-food products providing both health and medical benefits
-low cost genetic testing of risk factors for chronic diseases.

*New regulatory agency changes coming near future are-
-patients taking action themselves without waiting for a regulatory agency to pave a way for them
-the uberification of health care-ii is on -demand care delivery services gain popularity like uber taxi industry,which make transportation at lower prices.
-wearables(health trackers),insideables(devices implanted into the body to enable to open laptops,smartphones or even garage door) ,digestables(pills or tiny gadgets that can be swallowed to track digestion and absorption of drug)

*predictions for ACA success-reduced cost for health services without compromising quality care
-insurance coverage packages must be revised regardless of economic status and demographic variables.

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