The latest major Obamacare provisions to go into effect will require hospitals to modify their care-delivery and medical treatment services in order to improve clinical quality measures, consumer assessments of care, and curb excess readmission rates. These goals are under two separate provisions of the law, though both will involve monetary and funding incentives in an effort to encourage higher quality, more-efficient hospital care.
The first part of the program, called the “Hospital Value-Based Purchasing Program,” will redistribute 1 percent of the total Medicare funding that about 3,000 acute-care hospitals receive by tying the funding to patient assessments and standard quality metrics. As Politico reports, the second part of the program — which addresses readmissions rates by withholding up to 1 percent of Medicare payments to hospitals that have high rates of readmission — is a bit more of a concern for public health advocates, who warn that the changes could put impossible burdens on safety-net hospitals if improperly implemented:
“I think we all see these programs as the first steps towards the way the system will be structured in the future and the way incentives will be structured in the future,” said Mindy Steinberg, director of government relations for the Association of Academic Health Centers. “But everyone needs to recognize that this is the first step in a long, complicated process.”
Blair Childs, a vice president at Premier health care alliance, told POLITICO that he thinks hospitals should be held accountable for readmissions but that “the policy is badly flawed.”
“It relies on insufficient risk-adjustment and will adversely impact at-risk communities,” Childs wrote in an email. Premier believes the readmissions program should be part of the value-based purchasing program, with fixed targets that hospitals can try to meet, rather than past performance.
Most health professionals seem to agree that Values-Based Purchasing Program is a positive, modest program that will eventually expand and encourage hospitals to increase efficacy. But penalizing hospitals based on readmissions has the risk of affecting the chronically ill or those with long-term mental health needs. Professionals argue that the specter of such adverse results merits careful implementation of the reforms and flexibility from the government on balancing patient needs with reducing wasteful readmissions. “If all the safety net hospitals get hit on readmissions, then we need to learn from that and make adjustments going forward,” Childs said.