Healthcare reform is causing hospitals to better manage care, increase the efficiency of their facilities and become more cost-effective. It is fair to say that this is a fluctuating scenario for the healthcare industry, with both positive and negative impacts in the way that hospitals operate. Efficiency Increases in efficiency efforts have streamlined costs and improved facility management over the last few years. However, there is a downside to streamlined efficiency care. National Nurses United, the country’s largest union of registered nurses, reports that opportunities to drive down costs have resulted in serious nursing job cuts, as well as overall staffing cuts. Many hospitals are focusing on budget cuts and reductions of labor, anticipating a scenario with lower patient census. One reason for this lowered census is the popularity of high-deductible insurance, leading many to defer medical care because of cost. At the same time, millions of Baby Boomers have switched to Medicare, which pays hospitals lower rates than other insurers. Healthcare Reform Will Hold the Bottom Line Most of uninsured costs are covered, gaining hospitals some funds that were written off in the past. The hope here is that more money will be available for providers, and an insured and theoretically, healthier population will lower cares and costs over time. This, of course, relates entirely to the hospital’s location and the amount of care received by indigent patients. A caveat to remember is the immense amount of coverage necessary for all the Medicare and Medicaid patients needing to be provided for. These patients indicate that it is many times difficult to find physicians, with the current attrition rate of doctors. Value-Based Care Healthcare is no longer about service volume and more about results through accountability for patients. Outcomes and their costs are being evaluated and hospitals meeting requirements are receiving extra federal funds as a reward. The downside of value-based care is cost of administration to attain these goals. A healthcare paralegal who graduated from paralegal degree programs says far more is now expected of hospitals in paperwork, care, and legal compliance. This is a direct result of the millions of new healthcare recipients seeking treatment. Legal Impact of Healthcare Reform Healthcare reform has brought many new, insured patients into hospitals, and this has created new revenue. However, many states refused to expand Medicare coverage for their populations, largely because there is no financial incentive to do so. As these financial conditions, plus federal penalties for readmissions continue, a shift is moving towards outpatient care. The Journal of the American Medical Association Internal Medicine reported that some of the seemingly worst-performing hospitals and most often penalized were dealing with serious variables such as low household income for patients and patients with low educational background and difficulty following instructions. These patients had trouble performing activities of daily living like feeding themselves and bathing, thus causing readmission penalty punishments for hospitals in certain locations. Healthcare reform has brought about many changes, for both patients and healthcare professionals. Hospitals are still adjusting to many of these and will continue to feel the effects of change over the next few years.