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.