Supreme Court upholds the ACA — so now what?
What does the Affordable Care Act mean for quality departments?
When the Supreme Court released its opinion upholding the bulk of the Affordable Care Act (ACA) at the end of June, most of the commentary focused on what the law would mean to consumers. But it also has implications for the healthcare industry at large, including a potentially positive impact on quality improvement and patient safety departments and personnel around the country.
Hospital Peer Review asked some stakeholders what they think this game-changing law will mean to the daily life of a quality improvement manager. Here's what they had to say.
"I think the decision will change things a lot for quality improvement departments," says Jeannie Kelly, RN, BA, MHA, LHRM, a quality assurance officer at Soyring Consulting in St. Petersburg, FL. "For a long time, you would see a quality improvement manager who wore multiple hats in a hospital. But now this law is putting more emphasis on quality. Staff will wear only one hat — quality — and departments will be expanding."
Kelly, who has 20 years experience working in healthcare, including working on CMS provider surveys, says one reason hospitals will undoubtedly opt to beef up their quality departments is that performance information will become more accessible to the general public than ever before. "It will be easier to access; the local media will pick up on the reports and do stories on which hospitals outperform which."
Add to that the increasing financial risk for hospitals that don't perform well, and it's clear that quality is going to be at the front of mind for every level of management at a hospital, on up to the C-suite and the board of trustees. "Patient safety, quality of care, and patient satisfaction are going to be huge indicators of how you get paid by CMS and other insurers," Kelly says. "There isn't going to be just lip service to issues like the continuum of care and how to ensure that patients don't bounce back. This is for real now. And because some hospitals are behind the curve on this already, there will be a scramble among some to improve their QI and safety performance."
This is a good thing, Kelly says, because people who used to ignore the intrinsic value of having more than one person working in a quality department are shifting their thinking. But it also means that the QI staff are going to be busy. "You will have to pay a lot of attention to detail. But you will have more funding and more staff, and there will be recognition of the value that you have provided all along."
Down the road in Palm Beach, physician business coach and board certified surgeon Michael Cassatly, DMD, says, "The act has reaffirmed the need for quality improvement, and for QI and safety managers to put a laser focus on the areas that cause harm." And he agrees that there will be money backing up that new emphasis on safety "to keep the hospital from losing revenue" through non-reimbursement for care that is the result of hospital-acquired infections or other preventable harm.
"In 2008, the government estimated that there was $17 billion in costs from patient harm, and that doesn't include the costs of lost work or malpractice claims," Cassatly notes. The deaths due to that harm are estimated to be around 180,000, which he calls "a moral, ethical, and now a financial problem."
One hospital consortium that Cassatly is working with figures that to be viable financially, it needs to save 5% or $300,000 in costs per year. Part of that savings can come from reducing harm, he says.
The thing is, that low-hanging fruit has been plucked by the most forward thinking QI departments. The next place to look, Cassatly says, is at how to improve communication — between patients and providers, between providers and nursing, therapists, labs, and other ancillary team members, and between providers themselves during transitions of care.
The act will have "profound and far-reaching effects on quality and patient safety in acute-care hospital settings," says Rich Temple, executive consultant with healthcare management consulting firm Beacon Partners, based in Weymouth, MA. "[The decision by the Supreme Court] truly cements into place the myriad of incentives and reporting requirements surrounding the provision of quality care and reporting and measuring quality outcomes."
Most important to quality professionals is the concept of Accountable Care Organizations (ACOs), Temple says. "If the ACO can demonstrate cost savings, while likewise demonstrating a high quality of care, it gets to share in the cost savings through the ACO program. This will undoubtedly catalyze a focus on quality to take advantage of these benefits; it also will necessitate that hospitals look at quality holistically across all parts of a patient's continuum of care, as other providers' quality performance will have a direct impact on a hospital's ability to realize these benefits." In short, ACOs change the paradigm, he says, from one where more care and higher volume was always good for the hospital's bottom line.
Other areas of particular concern for hospital quality and safety officers revolve around the ACA's potential payment reductions built into it as part of the cost-saving component of the legislation, says Temple. There is the stick of reducing reimbursements, but there is also a carrot for hospitals that meet and properly report quality measures for specific conditions — AMI, heart failure, pneumonia, surgery, and healthcare-associated infections.
This carrot "will force hospitals to look at their service line offerings, their core competencies, their alignment with other provider organizations, and many other aspects of their strategic planning," he notes. "What will it take for the hospital to be successful in realizing these incentives? How is the data collected and aggregated to appropriately capture and report on these metrics? This is a big deal, and a big deal that providers will not be able to walk away from."
Temple also notes that the penalties for avoidable readmissions will impact the QI manager. "Processes need to be built to understand — in detail — where hospitals will be at risk. Analyses will likely take on many forms: by unit, by time of day, by primary physician, and many others. The infrastructure — both human and technological — that will have to be built to support this is substantial, but the risk of not going down this road is great."
It is "game changing" legislation, Temple says. "It impacts clinical care, strategic planning, revenue cycle processes, and virtually all other aspects of a hospital's operation. A provider would be very well served to undertake a detailed plan to assess its readiness to take on these new challenges in the new healthcare paradigm that the ACA has created."
While it's monumental legislation, not everyone agrees that the ACA is going to have a huge impact on quality professionals — at least not compared to other rules, regulations, and realities impacting them. "Healthcare organizations are facing a rising number of challenges that require involvement of quality professionals," says Patrice Spath, RHIT, a healthcare consultant with Brown-Spath & Associates of Forest Grove, OR, and the consulting editor of HPR. "Sure, there are some new measurement requirements and quality expectations in the Affordable Care Act, but there's much more going on right now that impacts quality professionals."
Among the examples she cites is the increased use of electronic health records in an effort to comply with the meaningful use requirements of the HITECH Act. "This transition requires that quality professionals interface with IT experts and learn how to extract reliable measurement data from electronic sources."
Still, there will, indeed, be an impact on your daily work from the ACA. For instance: The act includes a 3.5% tax on medical equipment that goes into effect in 2013. "This will result in hospitals paying more for medical equipment and they will often be unable to recoup these additional costs," says Spath. "Quality professionals will be even more involved in helping their facility identify ways to save money and improve efficiencies."
For more information on this topic, contact:
• Jeannie Kelly RN, BA, MHA, LHRM, Quality Assurance Officer, Soyring Consulting, St. Petersburg, FL. Telephone: (727) 822-8774.
• Michael G. Cassatly, DMD, Certified Business Coach and Board Certified Oral & Maxillofacial Surgeon, President, MedAchieve Inc. Palm Beach, FL. Telephone: (561) 747-8550.
• Patrice Spath, RHIT, owner, Brown-Spath Associates, Forest Grove, OR. Email: [email protected].
• Rich Temple, Executive Consultant, Beacon Partners, Weymouth, MA. Telephone: (781) 982-8400.
When the Supreme Court released its opinion upholding the bulk of the Affordable Care Act (ACA) at the end of June, most of the commentary focused on what the law would mean to consumers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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