The ACA & Healthcare Outpatient Services Impact Perspective

“Risk Shifting”

With the adoption of the Affordable Care Act (ACA), and shift from quantity to quality based reimbursement models, the healthcare landscape is shifting dramatically as to how providers are paid for their services.  The outpatient market is seeing a dramatic adjustment in volume of services based on this market demand.  According to a Health Facilities Management article (Health Forum, a subsidiary of AHA®): 

The Affordable Care Act is driving the trend towards outpatient construction, as hospitals and health systems adopt population health management and manage care across the continuum better, construction and design experts say. The findings in Health Facilities Management’s 2016 Hospital Construction Survey reflect this trend.

Compared with 2015 data, outpatient construction projects to address population health doubled across most categories. These included:

• Ambulatory surgery center (48 percent vs. 22 percent);
• Freestanding imaging (23 percent vs. 13 percent);
• Health system branded clinics in retail space (23 percent vs. 14 percent);
• Health system branded general medicine and family care in the community (53 percent vs. 24 percent);
• Immediate care facilities (49 percent vs. 17 percent);
• Medical office buildings (60 percent vs. 22 percent);
• And telehealth (23 percent vs. 9 percent).
• Medical office buildings saw the biggest jump in adoption over the prior year.

Further evidence of the market shift is validated through this industry trend highlighted in Modern Healthcare® excerpt: “New public policy and marketplace incentives are encouraging health systems to promote prevention and keep patients with chronic diseases out of the hospital. The shift to outpatient care, underway for decades, is accelerating”.

So one may ask, how does this market shift impact my outpatient care model as it relates to risk exposure?  Quite simply, it may adversely impact your business model more than you could have anticipated.  Your model must account for anticipated losses associated with increased volume and higher than normal patient health acuity that may impact your exposure to worker safety (higher than normal w/c claims activity), patient safety (medical malpractice), and or regulatory/accreditation status, outstanding community reputation in jeopardy and placing your business at risk for unanticipated loss and negative press.  As with most businesses, it is wise to protect your investments and assets with every resource available to you.  At a minimum, you should have risk and safety management programs and processes in place to protect your assets as follows:

OSHA mandates that all businesses with greater than 4 employees have a written safety management program that outlines requirements such as the OSHA Poster, Posting of your 300 Log, have a system in place to educate your employees upon hire and annually thereafter of the occupational/physical hazards they can expect to encounter on a daily basis, how to report concerns to be rectified, how to report injuries and where they can obtain treatment for those injuries, in addition to many other requirements. Your insurance carrier may also require additional measures to ensure that your coverage adequately addresses all risks, hazards, and exposures.

In today’s healthcare environment, a patient may relay a concern or complaint to your local Authority Having Jurisdiction (AHJ) like the Department of Public Health, Department of Health (Human Services), Fire Department, or other regulatory body (OSHA) exposing your business to unanticipated actions that can be extremely costly, interrupt your services, or suspend your ability to provide services altogether.

Sources: HFMMagazine.com & ModernHealthcare.com

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