The Affordable Care Act (ACA or Obamacare) drove results as far as ensuring that Americans had access to affordable health insurance (for the most part). However, the second half of the act -- the part that focuses on improved quality of care, healthcare access, and payment reform -- has left much to be desired. How healthcare facilities function is just as important, if not completely paramount, to how the bills get paid, especially when it comes to holding medical professionals accountable for their contribution to patient deaths and public health crises such as the opioid epidemic.

In 2015, 2 million Americans were recorded as having suffered from substance abuse disorders related to prescription opioid pain relievers, and in 2016, it was reported that medical errors were the third leading cause of death in America, behind heart disease and cancer, with over 200,000 deaths being related to these errors. These numbers are only small glimpse into the dark reality that comes with the quality of healthcare in America, and while doctor's groups such as the Council of Accountable Physician Practices (CAPP) aim to solve these problems within the context of what is in their best interest, it's time to advocate for reforms that effectively evaluate the quality of care rendered instead of simply reworking how the numbers game is played. 

Real Healthcare Reform: Patients Over Profits

Requirement to Accept Payment - Even though the ACA has ensured that millions more Americans now have health insurance, healthcare facilities still have the discretion to choose which forms of payment or insurance care plans that are willing to accept or deny. Some facilities have been known to deny cash payments. Others, especially those dealing with seniors, pick and choose which insurance providers they want to accept, even when the patient has Medicare. These failures to accept payment have prevented patients of all demographics to still go without quality care, defeating the purpose legislating that all Americans have health insurance.

The Urban Lobby is advocating for legislative language that requires all healthcare facilities to accept all forms of payment, including cash and all insurance plans, especially Medicaid and Medicare, that provide coverage for the most vulnerable populations. Additionally, any current loopholes that allow insurance companies to refuse to issue payment to healthcare facilities must be closed.

Quality Care Enforcement - CAPP advocates for a value based system that can currently be found in various Accountable Care Organizations (ACOs). While this sentiment seeks to incentivize medical professionals to do the right thing by tying payment to quality of services rendered, it is still unclear how to effectively measure quality of care.  As it stands, doctors themselves and third party payers (such as insurance companies and government agencies for Medicaid and the healthcare exchange) would evaluate the quality of care. 

Here's the issue: how can the public trust that medical professionals will always be forthcoming about their mishaps and shortcomings? How can quality of care be effectively determined by insurance companies or government agencies strictly dedicated to making sure healthcare is paid for? Neither can effectively happen. Neither will properly drive the results needed to look out for the best interest of patients.

The Urban Lobby is advocating for legislation that has the potential to open up a new market and not only help patients and families alike but also create jobs for medical professionals, young, old, practicing, and retired. Third party quality care firms staffed by medical professionals who will have additional training to act as patient advocates. These professionals will consist of doctors, hospitalists, nurses, and specialists of all kinds who are assigned to new patients and cases as a built in second opinion and overseer to ensure quality of care for patients.

From opting to act as sitters for 24-hour observation of in-patient care to by-appointment advocates who attend appointments with patients and their families to ensure proper prognoses are given, these medical professionals will have the opportunity to use their experience and expertise to personally advocate for patients and ensure quality care. Positions can be offered on a part-time or full-time basis, and the advocacy firm cannot be directly affiliated with any healthcare facility. The patient and family will have to choose a firm to work with, and the liaising will go from there, and insurance plans will be required to cover these services to ensure quality of care.

Staffing and Resource Allocation Requirements - One of the biggest complaints from medical professionals is that they are unable to provide quality care because they are understaffed and don't have enough resources. The Urban Lobby is advocating for legislation that sets a staffing and resource requirement for healthcare facilities to have available at a bare minimum at all times.

For example, instead of healthcare facilities scheduling 1 nurse and 1 assistant per patient, leading to one nurse and 2 assistants being responsible for 16 patients, the requirement would be for 1 nurse and 2 assistants to be assigned no more than 3 patients at any given time.

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