For all the divisiveness between classes about the ACA, the ACA's implementation of "pay-for-performance" or quality-based reimbursement benefits the poor and rich alike. Historically all healthcare providers and systems have been based on a "fee-for-service" model. What that means that is that folks are paid based on each episode of care. While this makes sense at first glace, it actually incentives poor medicine.
For example, if you came to see me because you had hand pain after falling I get paid for that visit. However, if I miss a diagnosis of a bone fracture and instead treat you for a sprained wrist so you have to come back again a month later for a second visit because things have gotten worse, not better, I get paid again -- something that probably would not have happened if I had made the right diagnosis to begin with. I get paid more for poor doctoring than good doctoring.
There are no service industries that behave this way. Everywhere else all the services that are required to make up for the mistake are free. Recently the manufacturer of my car put out a recall on dashboards. They paid for the labor and parts to replace it because they were the ones who messed up in the first place. In healthcare, that's not the way it's worked. The most egregious example I can think of? If your surgeon amputates the wrong leg (an unfortunate mistake that actually has happened), they get paid for the surgery that cut off the wrong leg and the surgery that they do next to cut off the correct one.
Three of the best programs that the ACA established are Medicare's Hospital Value-Based Purchasing (VBP) Program, Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. Medicare, the largest insurer in the country heavily influences the practices of all other insurance companies.
In a nutshell the VBP rewards entities that score well on certain metrics that range from clinical (e.g. speed of treating of heart attack) to patient experience to efficiency. Those that score poorly get reduced payment with the fee reduction invested into programs to improve their quality outcomes.
The Readmissions Reduction Program and the HAC target common complications that are preventable. For example, if you are discharged from the hospital after having a heart attack too soon and have to be readmitted a few days later for complications, the second admission was preventable. Medicare can now track readmission averages based on risk and reward hospital systems with low readmission rates.
The HAC looks at common complications, for example surgical site infection and catheter-associated infections, and rewards hospitals with lower rates of preventable complications.
While we don't like to admit it, reimbursement really drives care. I started my medical training before the implementation of this and the change has been remarkable.
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