Evaluating ACA's effects 'complicated'
On reducing 30-day readmissions, for example, Goldmann says, "I don't think it's reasonable to think that the American hospital system is going to immediately initiate all the improvements and best practices that lead to improvement in readmissions, especially since improvement will require partnership between hospitals and community providers. Hopefully, improvement will accelerate next year as interventions start to take effect."
He adds that "evaluating the effect of the (law) per se is complicated because some of the outcome measures were already improving as a result of previous efforts."
For example, a 2008 law determined that CMS would not pay for care necessitated because of certain preventable hospital-acquired conditions such as falls, medication errors and pressure ulcers. Other quality improvement organization efforts predate the ACA. And certain types of healthcare-associated infections have been dropping for several years, led by early adopters following checklists and with aggressive campaigns from the Centers for Disease Control and Prevention.
CMS could 'do a better job' of communicating
Of course part of the challenge in getting providers to embrace quality in the past has been the fact that for the most part, healthcare consumers don't understand that the healthcare system is far from uniformly good, Blair Childs, vice president for Premier healthcare alliance, a quality improvement organization with 2,400 hospitals, said in an interview.