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More in the Affordable Care Act than the Mandate

From: The Hospitalist, June 2012

The dual purpose of the ACA is patient protection and cost control.

by Joshua Lapps

As America weighs the value of healthcare and health reform, many moving parts of the Patient Protection and Affordable Care Act (ACA) will continue to reshape the healthcare system. And hospitalists continue to be part of the reshaping.

The full title of the bill should serve as a reminder to hospitalists of the dual purposes of the ACA: patient protection and cost control. The bulk of popular consciousness about the ACA focused around the favored positions (no pre-existing conditions and children remaining on parents’ plans until age 26) or around points of contention (the individual mandate and the Medicaid expansion).

The lesser-mentioned provisions centering around cost, quality, and payment reform have the potential to substantively reframe the conversation, particularly from the provider perspective. Hospitalists have a unique expertise that positions them to be critical in shaping these programs and regulations.

Two initiatives aim at moving the traditional fee-for-service models of payment for health services toward pay-for-performance. Both the hospital value-based purchasing and physician value-based payment modifier use quality measures to link the performance of care with payments. Hospitals and associated groups are in the process of working with the Centers for Medicare & Medicaid Services (CMS) as the value-based purchasing program moves forward.

The physician value-based modifier will combine quality measures and reports, similar to the 2010 Quality and Resource Use Reports piloted this year in Nebraska, Iowa, Kansas, and Missouri, with a to-be-determined payment adjustment. These reports represent a major step toward Medicare providing large-scale feedback to providers on healthcare quality and costs. When the modifier is enforced, a percentage of payments will reflect quality scores, making the feedback from hospitalists important in creating meaningful and useful measures.

The lesser-mentioned provisions centering around cost, quality, and payment reform have the potential to substantively reframe the conversation, particularly from the provider perspective. Hospitalists have a unique expertise that positions them to be critical in shaping these programs and regulations.

Concurrently, the ACA spurred the development of additional quality-improvement (QI) programs. Quality efforts ranging from reducing hospital-acquired infections, stemming preventable complications, meaningful use of electronic health records (EHRs), and reducing readmissions round out a complement of programs that strive to create safer, more cost-effective care for patients. For example, the Partnership for Patients is a collaborative program between providers, patient groups, and the government that catalyzes care improvement in hospitals. Hospitalists have been QI leaders at the front lines in their hospitals for years, affording an informed perspective on policy development.

The ACA is a constellation of programs and initiatives that seek to test new systems for care delivery and payment reform while providing access and quality protections for patients. Even without the ACA, reforms in quality and payment models are necessary and will occur.

Through SHM, hospitalists actively are sharing their experiences with policymakers in an effort to create responsive and reflective programs. It is precisely this expertise with hospitalized patients that affords hospitalists a ground- and systems-level perspective on healthcare. With so many reforms taking place, it is vital that hospitalists remain connected and informed about these issues and engage the opportunities for policy leadership and feedback.

To get involved with SHM’s advocacy efforts, visit www.hospitalmedicine.org/advocacy.


This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at reprints@wiley.com. Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.

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The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.

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ISSN: 1553-085X