CMSA Today - Issue 1, 2014 - (Page 14)

The ACA and the Hospital Case Manager The Opportunity to Lead Change Staying ahead of the industry curve in the face of reform By Stefani Daniels, MSNA, RN, ACM, CMAC, and Hussein Tahan, PhD, RN S ince the passing of the Patient Protection and Affordable Care Act (ACA), hospital executives and others frequently have made reference to the "era of reform." Yet reform has been a constant presence of health care since the days of Florence Nightingale, and over the years, improvements in the delivery of care have been made constantly. Nevertheless, despite impressive past successes, there are still countless opportunities to further improve. The convergence of the quality, value, and financial dimensions of health care under the ACA highlights the issues facing acute care case management today and in the future. The ACA is a complicated piece of legislature. Its primary theme regarding hospitals is the opportunity to drive out inefficiencies from our health care system. These inefficiencies are well documented in the literature and add costs to an already unsustainable health care cost of more than $2.6 trillion, or nearly 18 percent of the total economic output of the United States. Currently, we spend roughly $8,508 per capita (OECD, Health Data 2013) but 14 CMSA TODAY our outcomes are equal to, or in many cases, less impressive than those of other developed countries. Comparisons can also be made domestically between the states. Researchers at the Rand Corporation and Dartmouth Atlas have demonstrated year after year that the variations in health care delivery across different geographical regions yield no significant differences in health care outcomes. Areas with high rates Issue 1 * 2014 * DIGITAL of per capita spending simply have higher rates of resource utilization including higher rates of minor procedures and greater use of specialist providers, yet quality and cost outcomes are not necessarily better. These differences imply that reductions in resource use can be made by improving efficiency in how care is provided to meet patient needs and the demands of the ACA. Such findings are also disturbing since they do not demonstrate enhanced value. Increased quantity of services do not equate to improved value. For hospital case management programs, the devil may be in the details; but improving efficiency and demonstrating value is one of the key features of contemporary case management practice under the ACA. Here are a few issues that

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2014

President’s Letter
CMSA Corporate Partners
Association News
The Opportunity to Lead Change
An Integrated Approach
Health Care Reform in the Military
Innovation as Necessity
Opioid Abuse Crisis
Index of Advertisers

CMSA Today - Issue 1, 2014