PPACA Care Provisions: Hospital-Acquired Infections

The Patient Protection and Affordable Care Act penalizes hospitals by reducing payments for treatment of hospital-acquired infections and imposes monetary penalties of hospitals with the worst HAI rates. The severity of this problem is covered in my previous posts below. In the US 1.7 million HAIs occur per year, killing 99,000 people. This is more people than are killed yearly by car accidents, breast cancer and AIDS combined. The annual cost of these infections is $35-45 billion.

Hospital-Acquired Infections September 1, 2010
Hospital-Acquired Infections October 6, 2010
Hospital-Acquired Infections July 11, 2011
Hospital Hazards September 1, 2011 (section on HAIs)

PPACA Care Provisions: Quality Measurements

The PPACA required that the results of the National Quality Strategy be measured by ten outcome measurements each for acute and chronic care diseases and for preventive and primary care. Health and Human Services has contracted with the non-profit National Quality Forum for these measurements. There are currently 598 endorsed quality measures on the NQF website.

Taking the first item on the list, asthma assessment, the American Medical Association-Physician Consortium for Performance Improvement (AMA-PCPI) was put in charge of this quality measurement and produced a standard that was adopted in 2009 and is currently undergoing maintenance. The measurement is published by the HHS Agency for Healthcare Research and Quality (AHRQ). For a layperson, a quality asthma assessment consists of at least two office visits in a calendar year by a person 5-40 years of age, at which daytime and night-time asthma symptoms are recorded, quantitative measurements of the person's ability to get air into and out of their lungs are made, asthma attacks are recorded, asthma's effects on the person's quality of life are determined, short-term and long-term drugs are evaluated, along with whether the drugs are actually being bought and used as instructed. Doctor-patient communication  and patient satisfaction are reported by National Asthma Education and Prevention Program/National Heart, Lung, and Blood Institute (NAEPP/NHLBI) guidelines.

PPACA Care Provisions: The National Quality Strategy

Having heard about the individual mandate and other insurance provisions of the Patient Protection and Affordable Care Act ad nauseum, I decided to use the Scribd document below as a basis for expanding on the care provisions of the law.

The PPACA mandates an annual report on the development and implementation of a national strategy to improve health care quality. The report is here and the executive summary is reproduced below.

Executive Summary  

The Affordable Care Act seeks to increase access to high-quality, affordable health care for all Americans. To that end, the law requires the Secretary of the Department of Health and Human Services (HHS) to establish a National Strategy for Quality Improvement in Health Care (the National Quality Strategy) that sets priorities to guide this effort and includes a strategic plan for how to achieve it. This report describes the initial Strategy and plan for implementation.

The National Quality Strategy will promote quality health care in which the needs of patients, families, and communities guide the actions of all those who deliver and pay for care. It will incorporate the evidence-based results of the latest research and scientific advances in clinical medicine, public health, and health care delivery. It will foster a delivery system that works better for clinicians and provider organizations—reducing their administrative burdens and helping them collaborate to improve care. It is guided by principles (available atwww.ahrq.gov/workingforquality) that were developed with input by stakeholders across the health care system, including Federal and State agencies, local communities, provider organizations, clinicians, patients, businesses, employers, and payers. Most importantly, the implementation of this Strategy will lead to a measurable improvement in outcomes of care, and in the overall health of the American people.

An update for 2012 is available here on the Agency for Healthcare Research and Quality website. Within the update, here is the FDA's section of the plan as an example of one of the eight agencies. There is a ninth section for agency leadership.

Priorities

Making care safer by reducing the harm caused in the delivery of care.

Safe Use Initiative. The Safe Use Initiative is an FDA Center for Drug Evaluation and Research nonregulatory program through which collaborative cross-health sector projects are created to better manage specific preventable drug risks and reduce preventable harm from FDA-regulated drugs. Adverse events from drug use are estimated to result in more than 4 million visits to emergency departments, doctors' offices, or other outpatient settings annually. Innovation and improvement of risk management approaches through collaborations between federal agencies and the broader health care community can reduce preventable drug harm through increased communication, engagement, and action across all sectors of public health and health care. The metrics will be based on the specific project's objectives and outcomes. FDA and interested collaborators will develop appropriate evaluation metrics to measure an approach's success.

The overall national goal is an improvement in way things turn out for someone who is receiving health care. This is commonly referred to as the outcome, and will be a topic of later posts. One of my earlier posts, Payments for Services, Payments for Outcomes has already touched on this topic.

Health Care Shalls in the Affordable Care Act