The Future of Nursing and Health IT

The Quality Elixir

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN

Disclosures

Nurs Econ. 2011;29(5):286-289. 

In This Article

New Medicare Quality Programs Under the Affordable Care Act

Three recently announced initiatives made possible through the Affordable Care Act (ACA) reinforce the strong desire to improve health care outcomes and reduce the unsustainable rising costs of care. The Partnership for Patients (Healthcare.gov, 2011b) aims to keep patients from getting sicker under our care, as well as helping them heal without complications. Targeted improvements of a 40% reduction in hospital- acquired conditions and a 20% reduction in hospital readmission rates for Medicare recipients by 2013 are the cornerstones of the program. With $1 billion in funds from the ACA and other programs, the U.S. Department of Health and Human Services will work with this public-private partnership to save more lives and improve the reliability of our health care system.

Medicare will shift some of its payments to hospitals, rewarding them for quality and not quantity beginning in October 2012 with the Hospital Inpatient Value-Based Purchasing Program (Health care.gov, 2011c). Funding for this program will come from a 1% reduction in current hospital payments, amounting to an approximate $850 million as a starting point in this transition.

Also on the horizon is the establishment of Accountable Care Organizations or ACOs (Health care.gov, 2011d). The proposed regulations call for providers and service organizations to come together to create patient-centered organizations that improve the coordination of care, engage patients as partners in decision making, and improve quality. ACOs would have to meet quality standards in five key areas: patient/caregiver care experiences, care coordination, patient safety, preventive health, and at-risk population/frail elderly health. What is the carrot? Share in the savings created from more effective and efficient care.

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