Thursday, September 18th, 2014

The Obameter

Require providers to report measures of health care costs and quality


"Require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care and costs."


Updates

Affordable Care Act ramps up carrots and sticks for health providers to collect, report data

President Barack Obama's 2008 campaign health care plan promised to "require providers to report measures of health care costs and quality."

The Affordable Care Act, which he signed in 2010, increases incentives and moves toward financial penalties to encourage certain health providers to do just that. More than two dozen sections in the law address data collection, public reporting and corresponding adjustments in government payments.

But the law stops short of "requiring” all "hospitals and providers” to do the kind of public reporting Obama promised. Rather, the law focuses primarily on Medicare providers — though that includes nearly all physicians —  and reporting that's voluntary and incentive-based.

The move toward collecting and publicly reporting measures of health care costs and quality didn't start with the Affordable Care Act. It's been a focus of the Centers for Medicare and Medicaid Services since at least the early 2000s, under various pieces of legislation — but programs were expanded and new ones added under the 2010 law.

Especially marked, say some experts, is the move beyond just incentive payments for hospitals to participate in reporting programs to a drop in funding for failing to participate.

"The financial penalties really take it up to a very significant level,” said Jane Hyatt Thorpe, an associate research professor at George Washington University Medical Center who co-wrote a brief on Medicare quality measurement. "It's a whole new world."

Still, most other programs, such as the Physician Quality Reporting System, still focus simply on incentive payments.

Beyond Medicare, there's work to get uniform reporting started in Medicaid and CHIP, the Children's Health Insurance Program. And eventually, quality reporting will be required for health plans that participate in new health insurance exchanges, said Apoorva Stull, communications manager for the National Committee for Quality Assurance, a nonprofit that has helped develop quality measures.

Obama promised to "require providers to report measures of health care costs and quality." While there's been progress under his administration, including under the Affordable Care Act, it stops short of a true requirement for all health care providers to participate. We rate this promise a Compromise.

Sources:

Government Printing Office, The Patient Protection and Affordable Care Act, March 23, 2010

Interview with Keith Maley, spokesman for the Health and Human Services Department, including via email, April 24-26, 2012

Interview with Jane Hyatt Thorpe, associate research professor, School of Public Health and Health Services, George Washington University Medical Center, April 24, 2012

Email interview with Andrew Ryan, an assistant professor of public health and Walsh McDermont scholar in the Division of Outcomes and Effectiveness Research at Weill Cornell Medical College, April 26, 2012

Email interview with Apoorva Stull, communications manager, National Committee for Quality Assurance, March 26, 2012

Email interview with Kara Carscaden, deputy press secretary, Obama campaign, March 29, 2012

Interview with Timothy Jost, professor at the Washington and Lee University School of Law, March 23, 2012

HealthCare.gov, "Administration Implements New Health Reform Provision to Improve Care Quality, Lower Costs," April 29, 2011

HealthReformGPS, "Medicare Quality Measurement and Reporting Programs,” Feb. 9, 2011

Health Affairs, "Public Reporting on Quality and Costs," March 8, 2012

Health Affairs, "State-Sponsored Public Reporting Of Hospital Quality: Results Are Hard To Find And Lack Uniformity," December 2010

Centers for Medicare & Medicaid Services, "Quality Initiatives - General Information," April 4, 2012

Centers for Medicare & Medicaid Services, "Quality of Care Center," accessed April 25, 2012

Centers for Medicare and Medicaid Services, "Physician Quality Reporting System," April 6, 2012

Centers for Medicare & Medicaid Services, "Affordable Care Act Gives States Tools To Improve Quality Of Care In Medicaid, Save Taxpayer Dollars,” June 1, 2011

New York Times' The New Old Age blog, "Found: Doctors Who Take Medicare," July 6, 2011

Health care reform bill includes requirement for more disclosure

Democratic plans for health care reform include new requirements for hospitals to report on health care-associated infections that develop in hospitals and demographic information associated with such infections.

The secretary of Health and Human Services is also authorized to make the information publicly available over the Internet. The secretary should also make an annual report to Congress with recommendations for reducing such infections.

This proposed new authority is a concrete step toward fulfilling this promise. So we rate it In the Works.

Sources:

U.S. House of Representatives Energy and Commerce Committee, HR 3962 - the Affordable Health Care For America Act

U.S. House of Representatives Ways and Means Committee, HR 3962 - Section by Section

Kaiser Family Foundation, Analysis of Affordable Health Care for America Act (H.R. 3962) , accessed Nov. 4, 2009