PPACA's Impact on Quality of Care Isn't Getting Its Due

Cheryl Clark, for HealthLeaders Media , July 12, 2012

Instead, the discussion has centered almost exclusively around access issues and consumer payments. It seems to be all about the legal arguments regarding coverage, and states' rights to care for the poor the way each state sees fit.

Like how much the public must spend to buy commercial insurance, how each state will create an exchange, what the fed's role will be in assuring that states do, how much in taxpayer dollars will be spent on subsidies, and who will be required to buy health insurance. 

Almost nowhere do I hear mentioned that within the act's 974 pages are provisions imposing greater pressure on hospitals to reduce high 30-day mortality rates and 30-day readmission rates, which signal poor discharge planning and healthcare provider follow-through.  

I’m hearing zilch about the law's requirement that how providers who are paid should be tightly linked with whether care was delivered according to the latest scientific evidence.

There's scant mention on the blogs or other media of the fact that the ACA penalizes hospitals whose patients suffer higher rates of preventable conditions such as falls, infections, or other serious medical errors. Or that it sets forth a process for establishing measures by which one can compare hospital emergency rooms, cancer care, ambulatory surgical centers, home health agencies, skilled nursing homes and patient experience, many of which are tethered to hospital payment determinations.

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8 comments on "PPACA's Impact on Quality of Care Isn't Getting Its Due"

Todd (7/19/2012 at 9:19 AM)
The legislation surrounding improving quality is a nonstarter. Hospitals will simply further cost-shift to employers to pay for their penalties associated with readmission and other expenses. Competition with other hospitals, especially international facilities to attract patients will improve care long-term, not some absurd government mandate. Government never does anything well.

Alton Brantley (7/13/2012 at 3:09 PM)
As Mark points out, the Supreme Court was asked to determine 2 things: First, could Congress impose the individual mandate, and second, could HHS withhold Medicaid funding if states do not participate in PPACA. Their ruling was solely on these two questions of law, not on any issue of healthcare. For the first issue, SCOTUS ruled that the mandate is a tax (filed by tax return, leveed against taxable income and approved deductions, and collected by IRS). Second, Congress has by the Constitution the right to levy taxes. But they denied that it fell under the Commerce clause. So the health insurance tax stands. For the second issue, SCOTUS ruled that failure to participate in the Medicaid expansion could not be penalized by withdrawal of current Medicaid support. (States rights vs Federal enumerated powers).

MkWs (7/13/2012 at 12:29 PM)
Hi Cheryl, These are things to hide because the public doesn't want to take the time to understand anything that doesn't fit in two paragraphs, political careers are no longer made on success but opposition, only policy wonks and clinical and research people understand the ins and outs of the topic of quality and how woefully inadequate it is, and finally because anyone who suggests our tech-driven, high-touch, expensive, and well-salaried system is already anything but the world's best and is in need of improvement suddenly finds themselves in a room full of deaf ears. How about that for a few reasons? Wish it weren't so but I believe that aptly describes the environment for today's discussions on PPACA and the state of US health care today. Thank you for writing the article and bringing attention to a question that has been on my mind as well since mid-2009. Mark Wesson




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