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PPACA's Impact on Quality of Care Isn't Getting Its Due



In upholding most of the Patient Protection and Affordable Care Act, the Supreme Court validates improvements to quality and safety of care. But discussion has centered almost exclusively around access issues and consumer payments.



8 comments on "PPACA's Impact on Quality of Care Isn't Getting Its Due"
Todd (7/19/2012 at 9:19 AM)

The legislation surrounding improving quality is a nonstarter. Hospitals will simply further cost-shift to employers to pay for their penalties associated with readmission and other expenses. Competition with other hospitals, especially international facilities to attract patients will improve care long-term, not some absurd government mandate. Government never does anything well.
Alton Brantley (7/13/2012 at 3:09 PM)

As Mark points out, the Supreme Court was asked to determine 2 things: First, could Congress impose the individual mandate, and second, could HHS withhold Medicaid funding if states do not participate in PPACA. Their ruling was solely on these two questions of law, not on any issue of healthcare. For the first issue, SCOTUS ruled that the mandate is a tax (filed by tax return, leveed against taxable income and approved deductions, and collected by IRS). Second, Congress has by the Constitution the right to levy taxes. But they denied that it fell under the Commerce clause. So the health insurance tax stands. For the second issue, SCOTUS ruled that failure to participate in the Medicaid expansion could not be penalized by withdrawal of current Medicaid support. (States rights vs Federal enumerated powers).
MkWs (7/13/2012 at 12:29 PM)

Hi Cheryl, These are things to hide because the public doesn't want to take the time to understand anything that doesn't fit in two paragraphs, political careers are no longer made on success but opposition, only policy wonks and clinical and research people understand the ins and outs of the topic of quality and how woefully inadequate it is, and finally because anyone who suggests our tech-driven, high-touch, expensive, and well-salaried system is already anything but the world's best and is in need of improvement suddenly finds themselves in a room full of deaf ears. How about that for a few reasons? Wish it weren't so but I believe that aptly describes the environment for today's discussions on PPACA and the state of US health care today. Thank you for writing the article and bringing attention to a question that has been on my mind as well since mid-2009. Mark Wesson
Mark E. Shields, R.Ph. (7/13/2012 at 10:22 AM)

The Supreme Court did not validate policies contained within the act, it only determined that the act was constitutional. On page 2 of the opinion this is stated explicitly. "We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation's elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions."
Mandy McGee Stoll (7/12/2012 at 4:36 PM)

There may be some acceptable measures in the ACA such as pay for perfomance and incentives to provide quality care; but I object to the HHS mandate portion of the law which infringes on religious liberty, and the tax for not purchasing an actual commodity is abhorrent?
Steve B. (7/12/2012 at 2:36 PM)

I agree with your analysis that the focus is on cost without the additional focus on quality. I think that this will begin to change once Medicare enforces reimbursment through consisten quality metrics. Unfortunatly today quality and price have been set into a relationship that the better the quality the more I will have to pay for that. This has transended into the health care arena. But us Quality Freeks need to continue to encourage awareness in the quality our institutions provide.
Arun K. Potdar (7/12/2012 at 2:09 PM)

Excellent article and I agree with you 100 percent. Obama administration has made a mess of their own great achievement by simply reacting to propaganda dished out to American Consumers by the Tea Party and others opposing the ACA. I am not sure why they are all the time defensive about the Act and why they waited for Supreme Court's Decision as if they had doubts. They points raised in this article should have been picked up by the Administration's mouth pieces and others so long before opponents of the law muddy up the issues and frighten the hell out of small businesses and seniors, Obama administration should have launched a preemptive strike by doing just what this article has done; put the best facts out and let the opponents run for the cover. Example is the mandatory requirement to provide health care by the small businesses applies to one with over 50 employees and I received a call from one friend in small business asking me where she is going to get money for the employee benefits and she only have ten employees. Employer won't fill jobs to stay under fifty is currently drummed up now but the absurdity of this argument is not exploited because hiring of employee is not determined by costs but by revenue stream and laying off is determined by cost of labor when revenues are expected to go down. If one gets an order of a million dollar he or she will not think twice about the health care costs but will hire to earn that million. You do not need rocket scientist to tell you that. I am glad this article brought out the weakness of Obama administrator's strategies and also the real improvements ACA will do. I have no doubt if opposition wins and ACA is repealed that very same people then will jump in the land fill and dig up all those extra ordinary improvement provisions at night and call it a new and improved Republican (Romni) Plan.
Justin (7/12/2012 at 2:03 PM)

"Affordable" is also in the name of the law, and any kudos about the "protections" should be tempered with the indisputable fact that the administrative costs will rise and will be passed on to members or to the taxpayer. So, let's not heap too much praise just yet.