How are ACA’s quality measures affecting health care?

On a recent What the Health podcast, where I’m a frequent guest, we took some listeners’ questions. One was about what CMS does with all the data it collects on quality from health care facilities and providers – and whether there’s any evidence that the quality reporting actually improves outcomes for patients.

Podcast host Julie Rovner turned to one of her KHN colleagues, Jordan Rau, for his insights. Rau has developed a subspecialty of crunching CMS data and finding the story it has to tell.

Here’s a lightly edited version of what Rau shared with us.

CMS uses data to identify and track systemic issues, such as use of antipsychotic drugs in nursing homes or hospital readmission rates. Under the Affordable Care Act, it began using the data to judge hospital and now nursing home performance – which can get penalties or in some cases bonuses based on their measured performance or improvement. The data is also made public for consumers and patients through Medicare web sites like Hospital Compare and Home Health Compare. One goal is helping both patients and providers to make better decisions. For instance, some hospitals now will not refer patients being discharged to nursing homes that are poorly rated on Nursing Home Compare.

Overall, these programs — both the financial incentives and the transparency ones — have led health care facilities to focus more on the specific things being measured and in many cases improve them. There is significant concern about unintended consequences — such as whether providers are neglecting areas of quality that aren’t being measured, and whether the redirecting of money to well performing facilities is widening the gap between financially strong and financially weak ones, since those with fewer resources have a harder time making improvements.

1 thought on “How are ACA’s quality measures affecting health care?

  1. Avatar photoMichael Millenson

    The concerns Jordan cites are legitimate. However, it’s important to keep in mind that the “Yes, but…” crowd is heavily funded — hospitals, nursing home industry, etc. On the other side, the patients who don’t get infections or aren’t sent to a lousy nursing home don’t know about the harm that was avoided, so, of course, can’t be quoted in a story. (And, yes, I’m aware of the new readmissions study.) In that same vein, the “I would have been doing all this other improvement if you hadn’t made me look at what you want to measure” line is impossible to disprove but, based on the resources devoted to quality improvement by most hospitals before the feds made it a priority, not darn likely. There are certainly exceptions. But skepticism is warranted.

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