BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives
Phillip March 12, 2024 No Comments

BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives

BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives

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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 firmly established before the enactment of the Affordable Care Act (ACA) in 2013. However, the ACA has significantly influenced the presentation and evaluation of healthcare initiatives. One notable effect of the ACA is the implementation of Performance Improvement Plans (PIPs) as part of quality initiatives. These initiatives include measuring hospital readmission rates and implementing Medicare’s pay-for-performance model for hospital systems. Hospitals are incentivized to meet and improve upon designated quality measures for selected patients, often those with acute and chronic conditions such as Congestive Heart Failure, Diabetes, Pneumonia, and COPD (Reineck & Kahn, 2013). Additionally, hospitals are assessed based on Hospital Acquired Conditions (HACs), with reimbursements reduced for those in the top quartile of HACs compared to the national average (Reineck & Kahn, 2013). These initiatives serve to hold hospitals accountable for the care they provide from admission to discharge.

Goals of the Affordable Care Act (ACA)

The ACA, enacted in 2010, aimed to reform the US healthcare system by expanding Medicare and Medicaid, with a primary focus on providing coverage for the uninsured. It introduced mandates for individuals to enroll in healthcare coverage and for employers to offer health insurance to their employees. While the individual mandate penalty was removed in 2018, the ACA persists with three core goals: making affordable health insurance accessible to more Americans, expanding Medicaid coverage, and supporting innovative medical care delivery (HealthCare.gov, 2021). These goals were intended to improve population health and increase access to healthcare services, particularly for those without insurance coverage.

BUS FPX 4123 Assessment 3 The Affordable Care Act Quality Initiatives

Measuring ACA Goals

The ACA’s goals are evaluated by tracking various indicators of care. Insurance companies provide enrollment data through attribution lists, offering insights into enrollment trends nationwide. Healthcare organizations report outcome measures, such as Length of Stay (LOS), which can indicate the quality of care provided. Additionally, re-admission rates are considered alongside LOS to assess effectiveness. The ACA emphasizes preventive care as a means of maintaining financial stability for healthcare organizations (Dlugacz, 2006).

Conclusion

While the overarching goals of the ACA are evident, achieving them involves addressing numerous sub-goals. No single measure can fully capture an organization’s performance; instead, a range of indicators must be considered. The ACA has prompted a focus on preventive care, chronic conditions, and collaborative healthcare delivery, highlighting 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