- Examples of significant acts in existence – AVA and HIPPA
- ACA- Affordable Care Act (2010) was designed to avail equitable healthcare services for all.
- HIPAA- Health Insurance Portability and Accountability Act (1996)
- HIPAA enables people to pay for healthcare using their insurance card anywhere.
- Regulations are always developed to enhance the existing laws, e.g, HIPAA Privacy Rule
Accreditation & Regulatory Agencies
- What is accreditation? – approval that standards have been met.
- What is regulation? – a set of rules that govern the practice
- The role of these bodies is;
- To ensure safe delivery of healthcare services
- To ensure quality healthcare services are delivered to all.
- These agencies have been quite effective in their roles.
Examples of Agencies
- State Department of Health and Human Service (DHSS)
- This is a regulatory agency that requires;
- Mandatory accreditation
- DHSS licensure
- Joint Commission on Accreditation of Health Care Organizations (JCAHO)
- This is an accreditation agency that doesn’t require mandatory accreditation.
- It however bars facilities that are not accredited from receiving state & federal health monies (Medicaid, Medicare)
Organizational Healthcare Policies
- Legal and regulatory requirements determine organization healthcare policies.
- Policies change from time to time to fit to the regulations given.
- Effective communication is very important in new policies development
- Adopting new policies might also require changing systems, thus making the organizations a bit unstable.
- The privacy rule- one example of a regulation that led to changes in organizational policies
- New CMS’s regulations have greatly affected healthcare industry
- Medicare’s Electronic Prescribing (eRX) Incentive Program- professionals who don’t comply are penalized.
- Physician Quality Reporting System (PQRS) physicians who don’t comply are penalized
- Value-Based Payment Modifier Program- professionals who don’t comply are penalized.
- Privacy Rule- all health service providers must change their information sharing policies to comply.
- Some of the trends in health care include;
- Personal tracking devices
- Patient-centered care
- Increased demand for data
- Data security
- These trends will potentially reduce the expenses on health care and increase efficiency in health care service delivery.
- Brown, B. (2015). Top 7 Healthcare Trends and Challenges from … Retrieved from https://www.healthcatalyst.com/top-healthcare-trends-challenge
- Greenfield, D., & Braithwaite, J. (2008). Health sector accreditation research: a systematic review. International journal for quality in health care, 20(3), 172-183.
- Murillo, M. (n.d.). Trends Affecting Healthcare. Retrieved from http://www.healthadministrationdegrees.com/articles/trends-affecting-healthcare/
- NCSL. (2016). Retrieved from http://www.ncsl.org/research/health/hipaa-a-state-related-overview.aspx