BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives

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Capella University

BUS-FPX4123 Quality Assurance and Risk Management

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Quality Measures and Initiatives Under the Affordable Care Act (ACA)

Before the enactment of the Affordable Care Act (ACA) in 2010, quality measures were already being implemented in healthcare systems. However, the ACA significantly impacted the way healthcare quality initiatives are presented and evaluated. A key change introduced by the ACA was the establishment of Performance Improvement Plans (PIPs). These initiatives focus on evaluating hospital readmission rates and the implementation of Medicare’s pay-for-performance model. The model incentivizes hospitals to meet and improve quality measures, particularly for patients with acute or chronic conditions, such as Congestive Heart Failure, Diabetes, Pneumonia, and Chronic Obstructive Pulmonary Disease (COPD) (Reineck & Kahn, 2013). Hospitals are also assessed based on Hospital Acquired Conditions (HACs), which measure preventable issues that occur during a hospital stay. Reimbursements for hospitals are reduced if they rank in the top quartile of HACs compared to the national average (Reineck & Kahn, 2013). These initiatives aim to hold hospitals accountable for the quality of care from the point of admission to discharge, ensuring better outcomes for patients.

Goals of the Affordable Care Act (ACA)

The Affordable Care Act, enacted in 2010, sought to reform the U.S. healthcare system, primarily by expanding access to health insurance. One of the main goals was to provide healthcare coverage to the uninsured, which was achieved through the expansion of Medicare and Medicaid. Additionally, the ACA introduced individual mandates for healthcare enrollment and required employers to provide health insurance for their employees. Although the penalty for not having insurance was eliminated in 2018, the ACA still aims to fulfill three core objectives: making affordable health insurance accessible to more Americans, expanding Medicaid coverage, and fostering innovative approaches to healthcare delivery (HealthCare.gov, 2021). These goals were designed to improve population health by enhancing access to healthcare services and ensuring that more Americans, particularly those without insurance, have access to essential care.

Measuring ACA Goals

The success of the ACA’s goals is assessed through a variety of performance indicators. Insurance companies track enrollment trends and provide data through attribution lists, which offer valuable insights into national enrollment patterns. Additionally, healthcare organizations report outcome measures like Length of Stay (LOS), which can indicate the quality of care provided to patients. Re-admission rates, in conjunction with LOS, are also used to assess the effectiveness of hospital care. The ACA places significant emphasis on preventive care, as it is seen as a method to maintain financial stability for healthcare organizations while improving health outcomes (Dlugacz, 2006). These measures help track the progress of the ACA in achieving its overall goals of expanding healthcare access and improving care quality.

Conclusion

The goals of the ACA are ambitious and multifaceted. Achieving them requires a nuanced approach, as no single metric can capture the full scope of an organization’s performance. The ACA has led to a greater focus on preventive care, the management of chronic conditions, and the need for collaborative healthcare delivery. Moreover, it highlights the importance of addressing health disparities while increasing insurance coverage across the U.S. healthcare system (CMS, 2010).

References

CMS. (2010). Read the Affordable Care Act, Health Care Law. HealthCare.gov. https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/

Dlugacz, Y. (2006). Measuring health care: Using quality data for operational, financial, and clinical improvement. Wiley.

HealthCare.gov. (2021). Type of plan and provider network. https://www.healthcare.gov/choosea-plan/plan-types/