ACA Turns Two; Has it Improved Quality of Care?

"Only people that study this understand that there is significant variation in quality. Most people don't have a clue that there's a problem in the system," he says. "So when you try to say things have gotten better, people say, 'Well, that implies they weren't good in the first place.' " Perhaps because of loyalty or disbelief, most people don't want to hear any reason not to trust their hospital.

In an interview this week, Patrick Conway, MD, director and chief medical officer for CMS' Office of Clinical Standards and Quality, the agency that uploads data to the Hospital Compare website, acknowledged that his agency could "do a better job communicating the message" about the ACA's positive impact on quality of care.

For starters, he says, his agency is about to release statistics showing dramatic improvement from the inpatient quality reporting program over the last five years, in which hospitals have been paid for reporting on outcomes and process measures, in exchange for increases in pay. That's not a result of the ACA, of course.

But "if you look at hospital value-based purchasing measures, we're still in the first performance year," Conway says. "I don't know the data yet, but our hypothesis is that if we have a pay for reporting program that sees decreases in mortality and improved performance on those measures, that as we move to VBP, where there's actually payment associated with performance, we'll at least see a similar and we think higher, increase."

Conway says he travels frequently across the country to visit hospitals "and every one I've visited literally has a dashboard of performance measures for VBP and is tracking them monthly, gauging their improvement. ... I'd say from a front line provider's perspective, hospitals are incredibly focused on these measures like experience, mortality, and care coordination. And I think we'll see those benefits bear out."