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Having been created with access to healthcare for every American citizen in mind, Medicare was initially believed to be the main tool in addressing the weaknesses of the American healthcare system. Although after the integration of the Medicare framework into the target environment, a range of issues remained unresolved, the basis for an improvement has been created, the Recovery Audit Contractor (RAC) Program being one of them (Lind et al., 2019). Implying that healthcare providers should be paid respective fees as a part of the fee-for-service (FFS) Medicare plans, the RAC program represented a window of opportunity for addressing the current financial accessibility of the services.
However, despite the benefits that the RAC framework was expected to produce, several major problems have been spotted when implementing it. As a result, multiple citizens have filed a range of complaints concerning the quality of the program and its implementation. As a rule, these types of complaints have been prevalent over the past several years of implementing the RAC framework. Namely, access to care for mental health disorders has been one of the foundational problems of the RAC system.
In addition, the unreasonably short length of hospital stay, which does not allow for a full recovery and, therefore, may induce the further development of health concerns, can be named as another common issue with the implementation of the RAC tool (Davis et al., 2020). The described issue is particularly concerning since the release of a patient with poorly addressed mental health issues from a healthcare facility too early will imply a threat both to the patient’s well-being and that one of the community. Namely, the patient in question may harm themselves or community members due to unaddressed mental health concerns (Lind et al., 2019). Therefore, the specified part of RAC must be amended immediately so that the program could be used to implement the treatment fully. Moreover, tools for observing patients’ behaviors and overall demeanor after the release from the hospital must also be introduced to prevent future relapse and, thus, increase the safety of the patient and the community altogether (Davis et al., 2020). While the specified measures will not amend the RAC tool completely, they will become the first steps toward enhancing the quality and accessibility of the Medicare system within the mental health nursing context.
Finally, when addressing the RAC-related complaints, one must focus on the issue raised by multiple patients when addressing the issues with the reviews of hospital bills. Namely, the increased delays in payments have been observed quite a number of times, thus confirming that the established RAC system has not been tested fully and still contains certain internal issues due to which errors occur when the RAC program is run. Given the fact that the RAC framework was built to safeguard the needs of a particularly vulnerable population, namely, patients with mental health issues, the threat of financial inconsistencies must be placed at the top of the list of concerns and suggested improvements for the RAC system.
Due to the lack of focus on the implementation of the RAC program and the control tools used to supervise it, the main problems have merged as a result. Specifically, delays, access to appropriate healthcare services, and the absence of a framework for continuing to support outpatients that have been released from mental health facilities should be listed as the top complaints that must be handled immediately. As soon as the specified issues are addressed, opportunities for improving the quality of mental healthcare will rise.
References
Davis III, C. M., Swenson, E. R., Lehman, T. M., & Haas, D. A. (2020). Economic impact of outpatient Medicare total knee arthroplasty at a tertiary care academic medical center. The Journal of Arthroplasty, 35(6), S37-S41. Web.
Lind, K. D., Noel-Miller, C. M., Sangaralingham, L. R., Shah, N. D., Hess, E. P., Morin, P., & Fernanda Bellolio, M. (2019). Increasing trends in the use of hospital observation services for older medicare advantage and privately insured patients. Medical Care Research and Review, 76(2), 229-239. Web.
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