Disproportionate Share Hospitals In Healthcare Case Study

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Disproportionate Share Hospitals (DHS) which once served as a safety net to the uninsured and underinsured is under threat to provide the population it was designed to help. Drastic budget cuts to this vital lifeline of the health care system could affect the health care needs of this vulnerable population. At the same time, there must be increased restrain to rein in the costs.
We cannot talk about DSH, without first discussing the role of safety net hospital play in the healthcare system. Per Bailit at el, ...” National data from 2012 reflect that low-income communities experienced 29 percent higher rates of hospitalization, longer average length of stay, and 9 percent lower average hospital costs compared to higher-income communities. Safety
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These people will eventually enter the healthcare system and DSH hospitals is where the will receive their care. Even after the full implantation of the ACA, in 2015 there were 25.8 million working-age Americans remained uninsured. In a recent study, there were increased deaths by 30,428 (52%), when compared to a pre-2000 cohort study. They attributed the increases in the mortality rate to the lack of follow-up care and simple fact that these people could not afford the medical care that they needed. Under the ACA there are provisions to cut the budget for DSH by $ 43 billion over the next seven years. With the American Taxpayers Relief Act (ATRA) extending the cut further into FY 2021 and FY2022, the budget is getting tighter. With a drastic cut in the DSH budget, there would be short falls to provide care for the vulnerable population. The blue-collar workers, people with just a high school diploma, Hispanics, African American, and other minorities will feel the greatest health impact.(SUMMARY OF PROVISIONS IN The American Taxpayer Relief Act of 2012; "Analysis of Current and Future Disproportionate Share Hospital Allotments," 2016; Davis & Kan, 2016; Neuhausen et al., 2014; Powell & Xirasagar, …show more content…
First, most notable is Section 3133 of the Affordable Care Act. It limits hospitals to only 25 percent of the amount they previously would have received under the current statutory formula for Medicare DSH. With such a drastic cut in the budget that fee of service care that is being provided becomes non-viable for most safety net hospitals. Another rule that is threatening DSH is the RIN 0938-AS92 Medicaid Program. The main rule is DSH limit is based only on uncompensated care costs. “..The hospital-specific limit prevents hospitals from receiving DSH payments above the level of any net uncompensated cost incurred in the treatment of Medicaid eligibility or uninsured individuals.” It will lead to gaps in reimbursement in the care provided, in turn, will lead hospitals to avoid taking on patients that are uninsured. Third, Medicare has reduced the length of stay that will be covered under DSH. This has led to Medicare and mixed payer patients to be discharged at a higher rate and for a shorter treatment. This has the greatest impact on the Medicare insured children who under the ACA provisions will see a higher discharge rate, when compared to non-Medicare patients. This might also force community hospitals, which serve as safety net hospitals, to close. This will evidently increase the distance that a person must go to find health care.(Colvin et

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