Historical Health Care Trend Analysis

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Assessment 3 Instructions: Historical Health Care Trend Analysis
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· Write a 2-3 page trend analysis paper to describe health care regulations and medical practice evolutionary changes for access, quality, and cost, including the significant milestone events for different time periods.
Moana is a newly appointedquality reporting analyst for a Northeast Accountable Care Organization (ACO). Her director tells her that the U.S. health care system is going through a quality revolution.The drivers of this movement are years of proposed, failed, and enacted legislation;many regulatory agencies lobbying for change;and the myriad of quality initiatives implemented before and after the Affordable Care Act. Other influences in this trend are Medicare, Medicaid, employer groups, and the managed care markets’ drive to improve quality and reduce costs. The beneficiaries of these plans—patients—want transparency of their services in regard to quality, safety, and cost.
To achieve these desired health service outcomes, private and public health systems work in tandem to reduce the burden of disease andincrease quality, while managing costs. They do this through programs such as Vaccines for Children (VFC) andWomen, Infants, and Children (WIC), the Substance Abuse and Mental Health Services Administration (SAMHSA), Healthy People (1990–2030), Program of All-inclusive Care for the Elderly (PACE), and many more. Moana’s director shares with her that all of these private–public health programs and initiatives, in addition to the significant advancements in medical education, research, and technologies, have led to one of the most highly regulated industries in the United Statesand the world today.
In this assessment, you will review the private and public health legislation, regulatory agencies, and quality initiatives that have catapulted the United States into the quality revolution that we are experiencing today. As this quality revolution continues, health care professionals can expect to see more innovations contributing to individual patient and population health quality initiatives, with many more regulations to come.
Scenario
You are a health care educator for a largeintegrated accountable care organization (ACO). You are tasked to work with a group of hospital executives to identify milestone events for three eras,the 1800s, 1900s, and 2000s, and identify trends from those events that impacted the health care industry. The trend analysis will consist of three critical measures:access, quality, and costs. Milestone events and trends identified for these three measures over time should include legislation, regulatory agencies, and quality initiatives in the various time periods. The finalpaper will be used in an annual strategic planning session attended by the ACO and hospital executives to demonstrate how the quality movement has evolved into a quality revolution.
Instructions
Write a 2–3 pagepaper in which you explain and analyzehealth care regulations and medical practice evolutionary changes for access, quality, and cost, including the significant milestone events from different time periods.
Complete the following:
1. Study theHealth Care Quality Evolution Milestone Events Chart [DOCX]to review the key regulatory or quality initiative events relative to the 1800s, the 1900s, and the 2000s.
2. The textbook is suggested as the most efficient resource for this assessment, or use at least two other resources from those provided with this assessment. You may also use resources you find on your own from theHistory of Health Care Researchtab in theHealth Care Administration Undergraduate Library Research Guideto research for theTrend Analysis Table: Evolution of Access, Quality, and Cost in Health Caretable in the appendix of theHistorical Health Care Trend Analysis Template [DOCX].
2. You are required to reference atotal of three scholarly sourcesin your paper.
2. Be sure to cite these references within the body of your paper correctly using APA style citations. Refer toEvidence and APAin the Capella Writing Center for help with using APA style.
. CompletetheTrend Analysis Table: Evolution of Access, Quality, and Cost in Health Carein the appendix for the assessment template.
3. For each time period, select 2 milestone events or regulations from theHealth Care Quality Evolution Milestone Events Chart [DOCX]that have affected each topic: access to health care, quality of health care, and cost of health care.
3. There should be a total of 18 milestone events or regulations in the completed table.
3. Include bullet pointswith notes that describe each event or regulation and how it impacted access, quality, or cost.
. Write an introduction for the paper using theHistorical Health Care Trend Analysis Template [DOCX].
4. Provide a brief explanation of the purpose of this historical trend analysis and how it might be used in your work as a health administrator(1 paragraph).
4. Where appropriate, reference significant health care milestones, regulations, and measures for access, quality, and cost.
4. Refer totheWriting Supportpage on Campus forresources to help you as you write and revise your paper.
. Use the Trend Analysis Table: Evolution of Access, Quality, and Cost in Health Caretable to write the body of yourpaper.
5. Complete theTrends and Regulationssection in the assessment template.
1. Provide a brief description of the key measures of health care services, which are access, quality, and cost(1–2 paragraphs).
1. In theHealth Care Accesssubsection, explain the significant trends and regulatory milestones associated withaccessto health care over the recent eras(1–2 paragraphs).
2. What U.S. legislation, regulatory agencies, and quality initiatives fromthe 1800s, 1900s, and 2000s have influenced access to health care services in the United States?
2. What does your milestone trend analysis reveal for access to care?
2. Include citations and references to specific regulations, events, or agencies.
. In theHealth Care Qualitysubsection, explain the significant trends and regulatory milestones associated with health carequalityover the recent eras(1–2 paragraphs).
3. What U.S. legislation, regulatory agencies, and quality initiatives fromthe 1800s, 1900s, and 2000s have influenced care quality in health care services in the United States?
3. What does your trend analysis reveal for care quality?
3. Include citations and references to specific regulations, events, or agencies.
. In theHealth Care Costsubsection, explain the significant trends and regulatory milestones associated with access to health carecostsover the recent eras(1–2 paragraphs).
4. What U.S. legislation, regulatory agencies, and quality initiatives from the 1800s, 1900s, and 2000s have affected health care costs for medical services?
4. What does your trend analysis reveal for medical service costs?
4. Include citations and references to specific regulations, events, or agencies.
· Complete theTrend Analysissection of the assessment template (1–2 paragraphs).
. Analyze the trends and regulations in health care access, quality, and cost to draw conclusions about the evolution of health care regulations and practice throughout the recent eras.
. Describe professional experiences or examples to illustrate the trends.
. Include citations and references to specific regulations, events, or agencies.
· Write the conclusion for the paper(1 paragraph).
· Briefly restate the trends revealed for health care access, quality, and cost.
· Draw a conclusion about how the milestones, regulations, and changes have improved, been neutral, or inhibited progress of the U.S. health care system.
· Summarize clear and concise conclusions of your trend analysis.
Additional Requirements
· Your paper should be 2–3 pages, in addition to thetitle page, appendix, and references page.
· Double space your paper, and useTimes New Roman, 12-point font, as indicated in the assessment template.
· Usea minimum of three resources. This mayincludeyour textbook and other course resources.
· Complete all parts of the assessment template, using the headings provided in the template.
· Support all points with credible evidence, in the form of APA citations.
· Include a references page in APA format with appropriate citations.
· Complete theTrend Analysis Table: Evolution of Access, Quality, and Cost in Health Carein the appendix of the assessment template.
Competencies Measured
By successfully completing thisassessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
· Competency1:Analyze trends in the U.S. health care system from a historical perspective.
· Identify health care legislative, regulatory agency, and quality initiative events in a trend analysis table of different eras.
· Competency2:Explain the development of health regulation and the evolution of medical practice.
· Explain the significant trends and regulatory milestones associated with access to health care over the recent eras.
· Explain the significant trends and regulatory milestones associated with health care quality over the recent eras.
· Explain the significant trends and regulatory milestones associated with health care costs over the recent eras.
· Analyze the trends and regulations in health care access, quality, and cost to draw conclusions about the evolution of health care regulations and practice throughout the recent eras.
· Competency4:Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others.
· Appropriately addresses all components of the assessment prompt, using the assessment description to structure text.
· Apply APA formatting to in-text citations and references.
Historical Health Care Trend Analysis Scoring Guide

CRITERIA

NON-PERFORMANCE

BASIC

PROFICIENT

DISTINGUISHED

Identify health care legislative, regulatory agency, and quality initiative events in a trend analysis table of different eras.

Does not identify health care legislative, regulatory agency, and quality initiative events in a trend analysis table of different eras.

Identifies some health care legislative, regulatory agency, and quality initiative events in a trend analysis table of different eras but does not include the most significant events for each topic.

Identifies health care legislative, regulatory agency, and quality initiative events in a trend analysis table of different eras.

Describes the most significant health care legislative, regulatory agency, and quality initiative events in a trend analysis table of different eras, and all of the events per topic are related or follow a consistent theme.

Explain the significant trends and regulatory milestones associated with access to health care over the recent eras.

Does not explain the significant trends and regulatory milestones associated with access to health care over the recent eras.

Explains part of a trend or regulatory milestone associated with access to health care or does not select the most significant events that relate to the topic consistently across the eras.

Explains the significant trends and regulatory milestones associated with access to health care over the recent eras.

Explains the most significant trends accurately and in context using examples of the access to health care regulatory milestones from the appropriate time frames.

Explain the significant trends and regulatory milestones associated with health care quality over the recent eras.

Does not explain the trends and regulatory milestones associated with health care quality over the recent eras.

Explains part of a trend or regulatory milestone associated with health care quality or does not select the most significant events that relate to the topic consistently across the eras.

Explains the significant trends and regulatory milestones associated with health care quality over the recent eras.

Explains the most significant trends accurately and in context using examples of the health care quality regulatory milestones from the appropriate time frames.

Explain the significant trends and regulatory milestones associated with health care costs over the recent eras.

Does not explain the trends and regulatory milestones associated with health care costs over the recent eras.

Explains part of a trend or regulatory milestone associated with health care costs or does not select the most significant events that relate to the topic consistently across the eras.

Explains the significant trends and regulatory milestones associated with health care costs over the recent eras.

Explains the most significant trends accurately and in context using examples of the health care quality regulatory milestones from the appropriate time frames.

Analyze the trends and regulations in health care access, quality, and cost to draw conclusions about the evolution of health care regulations and practice throughout the recent eras.

Does not analyze the trends and regulations in health care access, quality, and cost to draw conclusions about the evolution of health care regulations and practice throughout the recent eras.

Describes some trends and regulations in health care access, quality, and cost and draws at least one conclusion about the evolution of health care regulations and/or practice throughout the recent eras, but does not provide a thorough analysis of both regulations and practice.

Analyzes the trends and regulations in health care access, quality, and cost to draw conclusions about the evolution of health care regulations and practice throughout the recent eras.

Analyzes the trends and regulations in health care access, quality, and cost to draw professional conclusions about the evolution of health care regulations and practice throughout the recent eras, supported by examples and references to the most appropriate milestones and professional literature.

Appropriately addresses all components of the assessment prompt, using the assessment description to structure text.

Does not address the assessment prompt.

Writing lacks a clear purpose or message that inhibits effective communication with the intended audience.

Appropriately addresses all components of the assessment prompt, using the assessment description to structure text.

Appropriately addresses all components of the assessment prompt and uses the prompt to guide organization. Additionally, shares information relevant to all assessment components at a level that communicates clear meaning.

Apply APA formatting to in-text citations and references.

Does not apply APA formatting to in-text citations and references.

Applies APA formatting to in-text citations and references incorrectly and/or inconsistently, detracting noticeably from good scholarship.

Applies APA formatting to in-text citations and references.

Exhibits strict and nearly flawless adherence to APA formatting of in-text citations and references.
Long-Term Care and Mental Health Services
· Young, K. M., & Kroth, P. J. (2018).Sultz & Young’s health care USA: Understanding its organization and delivery(9th ed.). Jones & Bartlett Learning.Available in the courseroom via the VitalSource Bookshelf link.
. Chapter 9, “Long-Term Care,” pages 245–274.
. Chapter 10, “Behavioral Health Services,” pages 277–299.
· Ernst, W. (2018).The role of work in psychiatry: Historical reflections.Indian Journal of Psychiatry, 60(6), S248–S252.
. This article outlines the history of psychiatry from 1751 to today and the changes within medical, social, and political contexts.
· Nadash, P. (2020).The evolution of long-term care programs comment on “Financing long-term care: Lessons from Japan.”International Journal of Health Policy and Management, 9(1), 42–44.
. This article reflects on lessons learned regarding social insurance, caregivers, and the financing of long-term care from Japan and Germany.
· Kaiser Family Foundation. (2015, August 31).Long-term care in the United States: A timeline.https://www.kff.org/medicaid/timeline/long-term-care-in-the-united-states-a-timeline/
. This website shows a timeline of 1935–2015 and the evolution, milestones, legislation, and funding of long-term care.
· National Institute of Mental Health. (2021).Important events in NIMH history.The NIH Almanac. https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-institute-mental-health-nimh#events
. This website shows a timeline of 1946–2015and the evolution, milestones, and advancements in mental health.
Health Care Quality
· Young, K. M., & Kroth, P. J. (2018).Sultz & Young’s health care USA: Understanding its organization and delivery(9th ed.). Jones & Bartlett Learning.Available in the courseroom via the VitalSource Bookshelf link.
. Chapter 11, “Public Health and the Role of Government in Health Care,” pages 301–349.
. Chapter 13, “Future of Health Care,” pages 371–390.
· Health Care Quality Evolution Milestone Events Chart [DOCX].
. Study the events on this timeline to determine trends in access, quality, and cost of health care throughout history. You will use the milestones on this timeline to research and write your assessment.
· Chan, D. C., Huynh, J., & Studdert, D. M. (2019).Accuracy of valuations of surgical procedures in the Medicare fee schedule.The New England Journal of Medicine, 380(16), 1546–1554.
. This article explains resource-based relative value scale based on relative value units (RVUs). It outlines physician work RVUs, practice expense RVUs, and malpractice RVUs and discusses room for improvements in this system.
· Devkaran, S., Patrick N O’Farrell, Ellahham, S., & Arcangel, R. (2019).Impact of repeated hospital accreditation surveys on quality and reliability, an 8-year interrupted time series analysis.BMJ Open, 9(2).
. This is an eight-year accreditation study of hospitals that demonstrate improved quality measure outcomes.
· Speer, M., McCullough, J. M., Fielding, J. E., Faustino, E., & Teutsch, S. M. (2020).Excess medical care spending: The categories, magnitude, and opportunity costs of wasteful spending in the United States.American Journal of Public Health, 110(12), 1743–1748.
. This resource contains several reputable landmark reports of hundreds of billions of dollars wasted in the United States on medical care every year with no improvements of health outcomes. It discusses six categories: clinical inefficiencies, missed prevention opportunities, overuse, administrative waste, excessive prices, and fraud and abuse.
· NCQA. (n.d.).HEDIS and performance measurement.https://www.ncqa.org/hedis/
. This website shows NCQA accreditation for managed care organizations (MCOs) and HEDIS quality reporting to demonstrate the MCO population health status.
· The Joint Commission. (n.d.).Accreditation basics for beginners.https://www.jointcommission.org/accreditation-and-certification/health-care-settings/home-care/home-care-on-demand-webinars/home-care-accreditation-basics-for-beginners/
. This website and video presentation show how accreditation is performed from beginning to end, including process, resources, and costs.

Historical Trend Analysis
Your Full Name (no credentials)
Capella University
BHA-FPX4002: History of the United States Health Care System
Instructor’s Name
2
1
Date
Historical Trend Analysis
Write your introduction here. Provide a brief explanation of the purpose of this historical trend analysis and how it might be used in your work as a health administrator (1 paragraph). Where appropriate, reference significant health care milestones, regulations, and measures for access, quality, and cost.
Trends and Regulations
Provide a brief description of the key measures of health care services, which are access, quality, and cost (1–2 paragraphs).
Health Care Access
Explain why access to health care is important and what it means. What U.S. legislation, regulatory agencies, and quality initiatives for the 1800s, 1900s and 2000s have influenced access to health care services in the United States. What does your milestone trend analysis reveal for access to care? (1–2 paragraphs)
Health Care Quality
Explain what quality health care is and why it is important. What U.S. legislation, regulatory agencies, and quality initiatives for the 1800s, 1900s and 2000s have influenced care quality in health care services in the United States. What does your trend analysis reveal for care quality? (1–2 paragraphs)
Health Care Cost
Explain what health care cost is and why it is important. What U.S. legislation, regulatory agencies, and quality initiatives for the 1800s, 1900s and 2000s have affected health care costs for medical services. What does your trend analysis reveal for medical service costs? (1–2 paragraphs)
Trend Analysis
Analyze the trends and regulations in health care access, quality, and cost to draw conclusions about the evolution of health care regulations and practice throughout the recent eras (1–2 paragraphs). Describe professional experiences or examples to illustrate the trends. Include citations and references to specific regulations, events, or agencies.
Conclusion
Summarize clear and concise conclusions of your trend analysis (1 paragraph). What are the trends revealed for health care access, quality, and cost? Draw a conclusion about how the changes have improved, been neutral, or inhibited progress of the U.S. health care system.
References
Kroth, P. J., & Young, K. M. (2018). Sultz & Young’s health care USA: Understanding its organization and delivery (9th ed.). Jones & Bartlett.

Appendix

Trend Analysis Table: Evolution of Access, Quality, and Cost in Health Care

Milestones

Health Care Access

Health Care Quality

Health Care Costs

1800s
Regulatory Legislation, Agencies, or Quality Initiatives

Year, Milestone
· Note
· Note

Year, Milestone
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Year, Milestone
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Year, Milestone
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· Note

Year, Milestone
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· Note

Year, Milestone
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· Note

1900s
Regulatory Legislation, Agencies, or Quality Initiatives

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

2000s
Regulatory Legislation, Agencies, or Quality Initiatives

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note
Remove or Replace: Header Is Not Doc Title

Health Care Quality Evolution Milestone Events Chart

Healthcare Legislation, Regulatory Agencies, and Quality Initiatives

Milestone Description

1) 1791 Regulating Healthcare

States were given the right to regulate health and formally began licensing physicians (Chaudhry, 2010).

2) 1800 State medical boards

State medical boards license, discipline, and regulate physicians and other health care professionals to protect the public (Truex, 2014).

3) 1850 First health insurance policy

The Franklin Health Assurance Company of Massachusetts was the first commercial insurance company in the U.S. to provide private health care coverage benefits for injuries not resulting in death (Scofea, 1994).

4) 1862 U.S. Army Medical Department and the United States Sanitary Commission formed

Post-Civil War, new health-related agencies, hospitals, and medical research and care implemented to care for the post-Civil War injured and increase population health awareness (Reilly, 2016).

5) 1886 U.S. Army established the Hospital Corps

The first U.S. data repository to collect medical data. This was implemented by the Surgeon General’s Office and the Library of the Surgeon General (Weedn, 2020).

6) 1900 Self-pay is the primary source of payment for healthcare services

Most Americans continued to pay their own health care expenses, which often meant either uncompensated charity care or no care. Hospitals were voluntary institutions that were privately supported (University of Pennsylvania School of Nursing, n.d.).

7) 1908 Workers’ compensation legislation

President Theodore Roosevelt signed legislation to provide workers’ compensation (WC) for certain federal employees in unusually hazardous jobs (U.S. Department of Labor, n.d.).

8) 1915 American Association of Labor Legislation (AALL)

The first universal access health insurance legislation. It would provide limited insurance benefits to working class, their dependents, and others who earned less than $1,200 a year. Although supported by the American Medical Association (AMA), it was never passed into law (Derickson, 2002).

9) 1916 The Federal Employees’ Compensation Act (FECA)

Replaced the 1908 WC legislation to include civilian employees of the federal government. They were provided medical care, survivors’ benefits, and compensation for lost wages under FECA (U.S. Department of Labor, n.d.).

10) 1920 Introduction of prepaid health plans (direct contracting)

Direct contracting between employers, local hospitals, and physicians for medical services was the first predetermined fee that was paid monthly or yearly basis. These prepaid health plans were the precursor of today’s managed care plans and capitation payments (Young & Kroth, 2018).

11) 1921 -1976 Indian Health Services (IHS)

The Snyder Act of 1921 and the Indian Health Care Improvement Act (IHCIA) of 1976 created the legislative authority for Congress to provide funding to Native Americans for health care services, which is now known as the Indian Health Services (IHS) (Warne & Frizzell, 2014).

12) 1921 Sheppard-Towner Maternity and Infancy Act

Legislation to reduce maternal and infant mortality. The Act was challenged and then said to be unconstitutional by the Supreme Court. Additionally, the Act was opposed by the American Medical Association. The act was not renewed and expired in 1929. (Moehling & Thomasson, 2012).

13) 1927 Workers’ Compensation Act

Office of Workers’ Compensation Programs (OWCP) administers FECA as well as the Longshore and Harbor Workers’ Compensation Act of 1927 and the Black Lung Benefits Reform Act of 1977 (Young & Kroth, 2018).

14) 1929 Blue Cross (BC) Insurance Policy

Baylor University, Dallas, TX, guaranteed schoolteachers 21 days of hospital care for $6 a year. Other groups of employees in Dallas joined, and in a short time period BC becomes hospital insurance nationwide (Young & Kroth, 2018).

15) 1930 Blue Shield (BS) Plans

Blue Shield (BS) was founded to provide insurance to lumber and mining camps of the Pacific Northwest at the turn of the century. Employers paid fees to medical service bureaus, which were composed of groups of physicians. BS becomes physician insurance nationwide (Young & Kroth, 2018).

16) 1938 The Food, Drug, and Cosmetic Act was signed by President Franklin Delano Roosevelt

Food, drug, and cosmetic safety implemented. The new law brought cosmetics and medical devices under control, and it required that drugs should be labeled with adequate directions for safe use (Young & Kroth, 2018; FDA, n.d.).

17) 1939 Wagner National Health Act (S.1620)

The bill would have allowed the states to implement mandatory and universal health care but did not pass due to WWII (United States national health program: Wagner, bill, S. 1620, 1939).

18) 1946 Hill-Burton Act

Provided federal grants for modernizing hospitals during the Great Depression and WWII (1929-1945). In return for federal funds, hospitals were required to provide services free or at reduced rates to patients unable to pay for care (Young & Kroth, 2018).

19) 1947 Taft-Hartley Act

Amended the National Labor Relations Act of 1932, restoring a more balanced relationship between labor and management. An indirect result of Taft-Hartley was the creation of third-party administrators (TPAs), which administer health care plans and process claims, thus serving as a system of checks and balances for labor and management (Achermann, 2009).

20) 1948 International Classification of Disease (ICD), World Health Organization (WHO).

Classification system used to collect diagnoses for statistical purposes. Originally used for mortality reporting but later and today used for morbidity reporting as well (Young & Kroth, 2018).

21) 1950 Major medical insurance

Birth of the major medical insurance for catastrophic and prolonged illness, with deductibles and lifetime maximum benefit amounts (Young & Kroth, 2018).

22) 1951 The Joint Commission (JC): Facility Accreditation

The Joint Commission does accreditation for hospitals and other medical facilities to ensure the facilities pass CMS, state and other inspections and ensure that services and facilities are safe and effective care of the highest quality and value (Young & Kroth, 2018).

23) 1956 Dependents’ Medical Care Act

The Dependents’ Medical Care Act of 1956 was signed into law and provided health care to dependents of active military personnel (precursor to CHAMPVA 1973 and now TriCare 1988) (Young & Kroth, 2018).

24) 1966 Social Security Amendments of 1965

Medicare-Title XVIII insurance for Americans over the age of sixty-five (65). Medicaid-Title XIX a cost-sharing program between the federal and state governments to provide health care services to low-income Americans (Young & Kroth, 2018).

25) 1966 Current Procedural Terminology (CPT)

The Current Procedural Terminology (CPT) codes were developed by the AMA in 1966 as a way to describe and track physician and other professional medical services. The CPT Code book is updated annually, and changes go into effect on January 1 of each new year (Dotson, 2013).

26) 1970 Controlled Substances Act (CSA); Drug Enforcement Agency (DEA): Controlled substances

Controlled Substances Act (CSA) was created to improve the manufacturing, importation and exportation, distribution, and dispensing of controlled substances. Manufacturers, distributors, and dispensers of controlled substances must be registered with the Drug Enforcement Administration (DEA) (Gabay, 2013).

27) 1970 Occupational Safety and Health Administration Act OSHA)

The Occupational Safety and Health Administration Act (OSHA) was designed to protect all employees against injuries from occupational hazards in the workplace (Young & Kroth, 2018).

28) 1972 Professional Standards Review Organizations (PSROs)

Created as part of Title XI of the Social Security Amendments Act of 1972 were Professional Standards Review Organizations (PSROs), which were physician-controlled nonprofit organizations that contracted with CMS to provide for the review of hospital inpatient resource utilization, quality of care, and medical necessity. The PSROs were replaced with Peer Review Organizations (PROs), as a result of the Tax Equity and Fiscal Responsibility Act of 1982, or TEFRA (Young & Kroth, 2018).

29) 1973 Health Maintenance Organization Act

The Health Maintenance Organization Assistance Act of 1973 authorized federal grants and loans to private organizations that wished to develop health maintenance organizations (HMOs), which are responsible for providing health care services to subscribers in a given geographic area for a fixed fee (Young & Kroth, 2018).

30) 1974 Employee Retirement Income Security Act of 1974 (ERISA)

ERISA is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans. This law allows employers to be self-insured (Young & Kroth, 2018).

31) 1975 U.S. Nuclear Regulatory Commission (NRC)

The NRC is a federal agency that ensures safe use of radioactive materials. They license and regulate the nation’s civilian use of radioactive materials to provide reasonable assurance of adequate safety for people and the environment. In health care this would include all diagnostic medical use, therapeutic medical use, and medical research use (United States Nuclear Regulatory Commission, 2020).

32) 1976 Food and Drug Administration (F.D.A.): Medical Equipment

FDA: Medical Device Amendments passed to ensure safety and effectiveness of medical devices, including diagnostic products (FDA, n.d.).

33) 1977 Health Care Financing Administration (HCFA)

The DHHS combine health care financing and quality assurance programs into one agency, HCFA. Medicare and Medicaid programs were transferred to HCFA, which is now CMS (Young & Kroth, 2018).

34) 1980 American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)

The AAAASF was established to standardize and improve the quality of health care in outpatient facilities. AAAASF accredits thousands of facilities worldwide including clinics, surgery centers, and state/federal health agencies, and patients acknowledge that AAAASF sets the “Gold Standard in Accreditation” (American Association for Accreditation of Ambulatory Surgery Facilities, n.d.).

35) 1980 Department of Health and Human Services (DHHS)

The Office of Education and the Department of Health, Education and Welfare (HEW) became the Department of Health and Human Services (DHHS) (U.S. Department of Health & Human Services, n.d.).

36) 1981 Omnibus Budget Reconciliation Act (OBRA)

The OBRA was federal legislation that expanded the Medicare and Medicaid programs. Government became more involved in nursing homes, including restraint restrictions (Svahn, 1981).

37) 1982 BCBS Association

The Blue Cross Association and the National Association of Blue Shield merge to create the BlueCross BlueShield Association (BCBSA) (Young & Kroth, 2018).

38) 1983 Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)

TEFRA created Medicare risk programs, which allowed federally qualified HMOs and competitive medical plans that met specified Medicare requirements to provide Medicare-covered services under a risk contract. TEFRA today is known as Medicare Part C or Medicare Advantage. The Act also enacted a prospective payment system (PPS), which is a predetermined payment for inpatient services based on diagnoses codes. The PPS went into effect in 1983 and is called diagnosis-related groups (DRGs), which is the hospital inpatient reimbursement system. Peer-review organizations (PROs), now called quality improvement organizations, or QIOs, were also created (Young & Kroth, 2018).

39) 1983 Inpatient Perspective Payment System (IPPS)

Medicare IPPS is how hospitals are paid for inpatient stays. Each admission is coded with ICD-10-CM diagnoses and ICD-10-PCS hospital procedure codes. Based on the reason for the admission and the severity of illness and procedures performed, the inpatient stay is assigned a Diagnostic Related Group (DRG). The hospital is paid a flat fee for the cost-based DRG. Reimbursement is based on the primary diagnoses, comorbidities and complications (severity of Illness) and procedures performed (Young & Kroth, 2018; Centers for Medicare & Medicaid Services, 2021a).

40) 1984 CMS Standardization of Information submitted on Medicare Claims

HCFA, now known as CMS, required providers to use the HCFA-1500 (now called the CMS-41500) to submit Medicare claims. The HCFA Common Procedure Coding System (HCPCS) (now called Health Care Procedure Coding System) was created, which included CPT, level II (national), and level III (local) codes. Commercial payers also adopted HCPCS coding and use of the CMS-1500 claim form. The CPT codes change yearly because technology and medical advancements drive the changes (Young & Kroth, 2018).

41) 1986 Consolidated Omnibus Budget Reconciliation Act (COBRA)

Provides workers and their families who lose their health benefits the right to continue those benefits for 18 months or 36 months due to the death of a spouse (Young & Kroth, 2018).

42) 1988 Clinical Laboratory Improvement Act (CLIA)

Clinical Laboratory Improvement Act (CLIA) legislation established quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed (Centers for Medicare & Medicaid Services, 2021b).

43) 1989 Agency for Healthcare Research and Quality’s (AHRQ)

The AHRQ mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable (Young & Kroth, 2018).

44) 1989 Health Plan Employer Data and Information Set (HEDIS)

The National Committee for Quality Assurance (NCQA) developed the HEDIS, which created standards to assess managed care systems using data elements that are collected, evaluated, and published to compare the performance of managed health care plans (Young & Kroth, 2018).

45) 1991 Standardized Evaluation and Management Codes (Physician Office Visit CPT Codes)

The AMA and CMS implement major revision of CPT, creating a new section called Evaluation and Management (E/M), which describes patient encounters where the physician must document for quality purpose; past, family and social history (PFSH), physical exam (PE), and medical decision making (MDM) (AMA, 1991).

46) 1991 National Committee for Quality Assurance (NCQA)

The NCQA ensures the quality of managed care plans by providing standard and objective information about HMOs (Marjoua & Bozic, 2012).

47) 1992 Resource-Based Relative Value Scale (RBRVS) system

Cost-based fee schedule for physicians under Omnibus Reconciliation Acts (OBRA) was created. Each CPT code is assigned a relative value unit (RVU) and multiplied with an annual conversion factor to reimburse the physician more cost-effectively based on their work, overhead, and risk of malpractice (McCormack & Burge, 1994).

48) 1993 Clinton proposed the Health Security Act of 1993

Based on six guiding principles of security, simplicity, savings, choice, quality, and personal responsibility (Young & Kroth, 2018).

49) 1996 National Correct Coding Initiative (NCCI)

The NCCI was created to promote correct coding initiatives and to eliminate improper medical coding. NCCI edits are developed based on coding conventions defined in the American Medical Association’s Current Procedural Terminology (CPT) manual (Centers for Medicare & Medicaid Services, 2021f).

50) 1996 Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The HIPAA established regulations that govern privacy, security, and electronic transactions standards for health care information. It also created portability of health insurance when an employee terms from their job. The primary intent of HIPAA is to provide better access to health insurance, limit fraud and abuse, and reduce administrative costs (Young & Kroth, 2018).

51) 1997 Balanced Budget Act (BBA); Children’s Health Insurance Plan (CHIP); OIG Fraud & Abuse Audits

Title XXI, State Children’s Health Insurance Program (SCHIP) established to provide uninsured, low-income children health insurance under state Medicaid programs. The Balanced Budget Act of 1997 (BBA) addresses health care fraud and abuse issues. The DHHS Office of the Inspector General (OIG) provides investigative and audit services in health care fraud cases (Young & Kroth, 2018).

52) 1999 Center for Improvement in Healthcare Quality (CIHQ)

The CIHQ is a membership-based organization comprised primarily of acute care and critical access hospitals, for which it provides accreditation services (Center for Improvement in Healthcare Quality, n.d.).

53) 1999 Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCE- SAA) amended the BBA of 1997 to require the development and implementation of a Home Health Prospective Payment System (HHPPS)

The OCE-SAA required the development and implementation of a Home Health Prospective Payment System (HHPPS), which reimburses home health agencies at a predetermined rate for health care services provided to patients. The HHPPS was implemented October 1, 2000, and uses the Outcomes and Assessment Information Set (OASIS), a group of data elements that represent core items of a comprehensive assessment for an adult home care patient and form the basis for measuring patient outcomes for purposes of outcome-based quality improvement (McCall et al., 2013).

54) 2000 Outpatient Prospective Payment System (OPPS)

Medicare’s OPPS is used to pay hospital outpatient services. Ambulatory Payment Classifications (APCs) are used to calculate reimbursement and is for hospital-based outpatient claims. It is a cost-based system that uses CPT codes and payment classifications to pay for similar services under group flat fee payments (Centers for Medicare & Medicaid Services, 2021e).

55) 2000 Benefits Improvement and Protection Act of 2000 (BIPA)

The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) requires implementation of a $400 billion prescription drug benefit, improved Medicare Advantage (formerly called Medicare+Choice) benefits, faster Medicare appeals decisions, and more (Young & Kroth, 2018).

56) 2000 Managed Market Competition; Consumer-driven health plans

Markets were consolidating and managed care was accelerating, and consumer were driving the insurance market-driven health plans. Consumers want the best health care at the lowest cost. Consumer-driving plans were, for example, employer-paid with high-deductible insurance plans with medical savings accounts used by employees to cover deductibles and other medical costs when covered amounts are exceeded (Well, 2002).

57) 2001 Administrative Simplification Compliance Act (ASCA)

The ASCA establishes the compliance date (October 16, 2003) for modifications to the Electronic Transaction Standards and Code Sets as required by HIPAA. Covered entities must submit Medicare claims electronically unless the Secretary of DHHS grants a waiver (Centers for Medicare & Medicaid Services, 2021c).

58) 2002 announced that quality improvement organizations (QIOs)

CMS OIOs perform utilization and quality control review of health care furnished, or to be furnished, to Medicare beneficiaries. QIOs replaced peer review organizations (PROs), which previously performed this function (Young & Kroth, 2018).

59) 2005 National Provider Identifier, NPI

The Standard Unique Health Identifier for Health Care Providers (or National Provider Identifier, NPI) is implemented (Centers for Medicare & Medicaid Services, 2021c).

60) 2005 Patient Safety and Quality Improvement Act of 2005

Amends Title IX of the Public Health Service Act to provide for improved patient safety and reduced incidence of events adversely affecting patient safety. It encourages the reporting of health care mistakes to patient safety organizations by making the reports confidential and shielding them from use in civil and criminal proceedings (Centers for Medicare & Medicaid Services, 2021c).

61) 2005 Deficit Reduction Act of 2005

Created the Medicaid Integrity Program (MIP), which is a fraud and abuse detection initiative and program (Young & Kroth, 2018).

62) 2006 Physician Quality Reporting Initiative (PQRI) or System (PQRS)

The Tax Relief and Health Care Act of 2006 (TRHCA) authorized implementation of a physician quality reporting system that establishes a financial incentive for eligible professionals who participate in a voluntary quality reporting program (Young & Kroth, 2018).

63) 2009 American Recovery and Reinvestment Act of 2009

The American Recovery and Reinvestment Act (ARRA) authorized an expenditure of $1.5 billion for grants for construction, renovation and equipment, and the acquisition of health information technology systems (Young & Kroth, 2018).

64) 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act

The Health Information Technology for Economic and Clinical Health (HITECH) Act provides DHHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT, including electronic health records and private and secure electronic health information exchange (Young & Kroth, 2018).

65) 2010 Patient Protection and Affordable Care Act (2010)

The PPACA (2010) provides quality affordable access to health insurance for Americans. The Act provides a broader range of mandated prevention services, where patients are not to be charged copayments or deductibles on those services to incent them to get the preventive services. The Act eliminates lifetime caps on benefits and extends coverage of college students to age 26 (Young & Kroth, 2018).

66) 2014 National Coordinator for Health Information Technology (ONC)

The ONC is the office that supports the administration’s healthIT.gov efforts. It is a primary resource to the entire health system to support the adoption of health information technology and the promotion of nationwide, standards-based health information exchange (HealthIT.gov, 2021).

67) 2015 Hospital Quality Reporting (HQR) and Initiative (H.Q.I.)

The HQR began in 2003, mandated by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. Failure to successfully report resulted in a 0.4 percentage point reduction in the annual market basket used in the reimbursement. This increased to a 2.0 percent reduction under the Deficit Reduction Act of 2005. Under the American Recovery and Reinvestment Act of 2009 and the Affordable Care Act of 2010 the reduction is one-quarter of the hospital’s applicable annual payment rate in 2015 and beyond if all Hospital Inpatient Quality Reporting Program requirements are not met (Centers for Medicare & Medicaid Services, 2021d).

68) 2015 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Merit-based Incentive Payment System (MIPS)

Repeals the Sustainable Growth Rate (PDF) formula, value-based purchasing. Implements MIPS, which combines the former PQRS reporting system with ePrescribe and meaningful use into the one program with four (4) components (Quality Payment Program, n.d.).

69)
2021 American Rescue Plan Act (ARPA)

The American Rescue Plan Act of 2021, also called the COVID-19 Stimulus Package or American Rescue Plan. The ARPA expands A.C.A. health insurance subsidies and lowers costs (Centers for Medicare & Medicaid Services, 2021c).

70) 2021 Medicare Care Compare

Medicare search engines that allow Medicare recipients to sign up, log in, and find and compare nursing homes, hospitals, physicians, other providers of care. There is also a look up externally for non-Medicare patients, but the data is limited. The compare data compares from the quality measures and cost data submitted through the quality reporting programs. The data provides transparency and was initiated by the consumerism movement in health care (Medicare.gov, 2021).

71) 2030-2000 Healthy People 2000, 2010,2020, 2030

Healthy People 2030 is the fifth decade of the program. Healthy People 1990 began a ten-year population health initiative. Every ten years since its inception goals have been set, population health data is measured and outcomes are analyzed. The 1990 to 2000 span of time was the baseline of the program. For Healthy People 2000, the second iteration of the initiative, was guided by 3 broad goals: a) increase the span of healthy life, b) reduce health disparities and c) achieve access to preventive services for all. For Healthy People 2010, the focus increased on improving quality of life. The one significant overarching goal was to eliminate health disparities and not just simply reduce them. For Healthy People 2020 there were four goals: a) attain a high-quality of life; b) live longer without preventable disease, disability, injury, or premature death; c) achieve health equity and eliminate disparities; and d) improve all groups in regard to health status. Finally, for Healthy People 2030, the fifth iteration rolled out in August 2021, there is increased emphasis on the lessons learned over the last 4 decades to improve health equity, health literacy, and a new concentration on well-being (Health.gov, n.d.; Kroth, & Young, 2018).
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