Affordable Care Act encourages health providers to report ‘hospital acquired conditions’
President Barack Obama"s 2008 campaign health care plan promised to "require providers to report preventable medical errors, and support hospital and physician practice improvement to prevent future errors."
The Affordable Care Act, which he signed in 2010, increases incentives and moves toward financial penalties to encourage health providers to report measures of health care costs and quality, the subject of a separate Obameter ruling.
We found 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.
To measure this promise, we"re also asking, did the law include "preventable medical errors”?
Andrew Ryan, an assistant professor of public health at Weill Cornell Medical College, points to a move toward "value-based purchasing” for some Medicare-paid acute-care hospitals. As part of value-based purchasing, such hospitals will have to measure "hospital acquired conditions,” which he says are basically measures of hospital preventable errors.
Their pay will partly depend on their performance.
The category "hospital acquired conditions” goes beyond "hospital acquired infections” to include things such as objects left in the body after surgery, dangerous air bubbles introduced into the bloodstream and mismatched blood types. But the list doesn"t include all preventable medical errors.
Obama promised to "require providers to report preventable medical errors, and support hospital and physician practice improvement to prevent future errors." That"s essentially happening for acute-care hospitals that are paid by a specific Medicare program. But while there"s been progress under the Affordable Care Act, it stops short of a requiring all health care providers to participate. We rate this promise a Compromise.
Government Printing Office, The Patient Protection and Affordable Care Act, March 23, 2010
Federal Register, Medicare Program; Hospital Inpatient Value-Based Purchasing Program, May 6, 2011
Health & Human Services Department, "Why Quality Measures are Important to You,” accessed April 26, 2011
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
Required reporting for preventable medical errors not in health bills
Democratic plans for health care reform do not require widespread reporting of preventable medical errors.
They do, however, take on the more limited issue of hospital acquired infections. The House bill requires hospitals to report only hospital acquired infections, not all medical errors. The Senate bill does not require public reporting but would penalize hospitals with the highest rates of hospital acquired infection.
Hearst newspapers analyzed the bills as part of their ongoing investigation, " Dead by Mistake ." Their reporting concluded that up to 200,000 people per year die from medical errors and infections in the United States.
"The bills drafted in five House and Senate committees do contain sections on health care quality and patient safety," the Hearst report said. "But despite a claim in one committee"s press release that its bill 'fixes' the problem of medical errors, most of the language focuses on research that"s already under way."
We rated Promise No. 62, Require providers to report measures of health care costs and quality , as In the Works, mostly on the basis of the requirements for hospitals to report on hospital acquired infections.
But there are many more types of medical errors than merely hospital acquired infections, and health care reform imposes no new reporting requirements on those errors. For this promise, the health care bills fall short of President Barack Obama's promise. So we rate this promise Stalled.
Dead by Mistake
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
Interview with William Vaughan, policy analyst for Consumers Union