The rush is on to prepare for the next phase of the Affordable Care Act.

One of the biggest questions is whether health insurance exchanges (HIX), or “marketplaces,” will be ready to sell their policies by the mandated date of October 1st of this year.  If they are, they will extend coverage to a first wave of nine million newly insured Americans beginning Jan. 1st, 2014.

As we have written many times in this column, hospitals will need to be prepared for this onslaught of new patients in addition to an entire generation of Baby Boomers, who are currently turning 65 at the rate of 10,000 per day.  In all, extended healthcare coverage will reach 30-40 million additional Americans when the ACA is fully implemented.

(TeleTracking’s Real-Time Capacity Management™ solutions were created in part to address this convergence of aging Boomers and the newly insured, because it helps hospitals optimize the capacity they aren’t aware they already have.)

The states and the federal government have only four months to get these “marketplaces” up and running. Hospitals have only three more months after that to be ready to accept a bolus of new patients. If your institution hasn’t made provisions for accommodating more patients than ever before, you might want to check out how America’s top hospitals use TeleTracking to manage their physical operations more efficiently. We’ve already prepared some 900 hospitals and health systems for the coming storm, including some of the top names in healthcare.

Right now the major focus is on the HIXs – because they are the main vehicle for purchasing health coverage under the ACA.  Other parts of the law are already in place, such as extending parent’s health insurance to their children to the age of 26 and increasing Medicaid drug rebates to 23.2 percent for brand name drugs. Still to come is a prohibition on insurance exclusion due to a pre-existing condition.  That will also go into effect next January.

When the law is fully implemented, all Americans must have health insurance or be subject to increasing tax penalties, although the Obama administration has said the penalties only apply to those taxpayers choosing not to get coverage “despite having ready access to affordable coverage.”  ACA also provides subsidies for consumers unable to afford their own insurance but not eligible for Medicaid.

To deal with the sharply rising increase in covered patients, the ACA and the Recovery and Reinvestment Act of 2009 have made provisions to fund additional health information technology investments. Since the enactment of those laws, the emphasis has been on implementing Electronic Medical Records (EMRs). As those investments wind down, healthcare executives will be considering technology-based operational improvements to insure they can deliver quality care to “satisfied” patients. Because of other provisions in the law, their insurance reimbursements will depend on it.

Where is your hospital in this transition? Will 2014 bring improvement to your hospital’s operational efficiency?


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