BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives

Student Name

Capella University

BUS-FPX4123 Quality Assurance and Risk Management

Prof. Name

Date

Quality Measures and Initiatives Under the Affordable Care Act (ACA)

Quality measures were well-established prior to the passing of the Affordable Care Act (ACA) in 2013. Nevertheless, the ACA has had a significant impact on the implementation and assessment of healthcare initiatives. Notably, the ACA introduced Performance Improvement Plans (PIPs) as a component of quality initiatives. These initiatives encompass monitoring hospital readmission rates and adopting Medicare’s pay-for-performance framework for hospital systems. Hospitals are incentivized to achieve and enhance designated quality measures for specific patient groups, often those with acute and chronic illnesses such as Congestive Heart Failure, Diabetes, Pneumonia, and COPD (Reineck & Kahn, 2013).

Furthermore, hospitals undergo evaluation based on Hospital Acquired Conditions (HACs), with reimbursements reduced for those ranking in the top quartile of HACs compared to the national average (Reineck & Kahn, 2013). These initiatives aim to hold hospitals accountable for the entirety of care provided from admission to discharge.

Goals of the Affordable Care Act (ACA)

Enacted in 2010, the ACA sought to overhaul the US healthcare system by expanding Medicare and Medicaid, with a primary objective of extending coverage to the uninsured. It introduced mandates for individuals to obtain healthcare coverage and for employers to offer health insurance to their employees.

BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives

Although the individual mandate penalty was eliminated in 2018, the ACA persists with three core objectives: enhancing accessibility to affordable health insurance for more Americans, expanding Medicaid coverage, and promoting innovative healthcare delivery models (HealthCare.gov, 2021). These objectives were intended to enhance population health and increase access to healthcare services, particularly for those lacking insurance coverage.

Measuring ACA Goals

The goals of the ACA are assessed through monitoring various care indicators. Enrollment data is provided by insurance companies through attribution lists, offering insights into nationwide enrollment trends. Healthcare organizations report outcome measures, such as Length of Stay (LOS), which can serve as indicators of the quality of care provided. Additionally, readmission rates are evaluated alongside LOS to gauge effectiveness. Emphasis is placed on preventive care under the ACA as a strategy to sustain financial stability for healthcare organizations (Dlugacz, 2006).

Conclusion

While the overarching goals of the ACA are apparent, achieving them necessitates addressing numerous sub-goals. No singular measure can comprehensively capture an organization’s performance; instead, a multitude of indicators must be considered. The ACA has spurred a focus on preventive care, management of chronic conditions, and collaborative healthcare delivery, underscoring the importance of addressing health disparities and expanding insurance coverage (CMS, 2010).

References

CMS. (2010). Read the Affordable Care Act, Health Care Law. HealthCare.gov. https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/

Dlugacz, Y. (2006). Measuring health care: Using quality data for operational, financial, and clinical improvement. Wiley.

HealthCare.gov. (2021). Type of plan and provider network. https://www.healthcare.gov/choosea-plan/plan-types/

Reineck, L. A., & Kahn, J. M. (2013). Quality Measurement in the Affordable Care Act. A Reaffirmed Commitment to Value in Health Care. American Journal of Respiratory and Critical Care Medicine, 187(10), 1038–1039. https://doi.org/10.1164/rccm.201302-0404ed

BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives