PPACA, High Tech Act Overlooks LTC Patients, Physicians and Facilities

May 11th, 2013 by Rod Baird

The concept behind the Patient Protection and Affordable Care Act (ACA) is pretty clear – everybody in the country deserves to have a primary care provider who is the “quarterback” of their healthcare.

That’s an easy thing to understand when you’re an ambulatory person. With an ambulatory health home, the physician controls everything directly because healthcare delivery originates in his or her office.


But the “quarterback” model doesn’t work for longterm care (LTC) physicians who care for people who are chronically ill and institutionalized.

Yes, LTC physicians are directly responsible for the care of the LTC patient – but they can only indirectly control the LTC facility. They’re often more like guests to the facility.

When the PPACA was written, no one actually thought to focus on the chronically ill people in institutions. But whenever you ask a policymaker if these people were intended to be included, the answer is a defensive “yes!” Meaning – “Oh shoot, I never thought about that. Of course those people were intended to be included.”

The same can be said for the American Recovery & Reinvestment Act of 2009 “high tech act.” This is the legislation that created incentives for the acquisition and implementation of Electronic Health Records.

The incentives for use of information management completely overlooked LTC facilities. There’s no statutory requirement or financial incentive for LTC facilities to implement information technology, and there’s no direction for them to interact with the LTC physician who is expected to use electronic records.

In fact, information sharing in the LTC world today is essentially nonexistent. There’s no data exchange. In fact, 98 percent of all information is shared only through phones, faxes, and handwritten notes, according to an informal poll we conducted among five large LTC physician groups, serving 10 different states.

And the high tech act fails to address this. If physicians who work in LTC use technology certified as an ambulatory health record, that physician (or nurse practitioner) is eligible for various incentives. There is no incentive for the LTC facility or the LTC pharmacy – each of which manages a critical part of the record required by the physician to complete the “Medical Home” record.

Even though the PPACA and high tech act have failed to include provisions for LTC information and patient management, the need to manage the high cost of LTC patients has become urgent. It’s common knowledge that these are by far the nation’s most costly patients, and the time to bring down expenditures through effective information system management and pragmatic approaches to LTC care is now.

Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

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