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New Quality ACA Reporting Standards

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ACA Reporting StandardsAffordable Care Act Updates ACA Reporting Standards

One of the major provisions in the Affordable Care Act (ACA) isthe new set of quality ACA reporting standards for all medical facilities. Hospitals, medical centers, outpatient centers, nursing homes, home health agencies,

etc. now have to provide yearly reports on their patient outcomes across 44 quality-of-care measurements.

These reports used to be voluntary, and technically still are, but refusal to participate in this program could cost a facility their Medicare/Medicaid reimbursements. For the vast majority of medical facilities, that’s not much of a choice.

In the past, patient outcome information was tightly guarded by hospitals, especially if it wasn’t good news. A few consumer groups gathered together what data they could, and put out annual hospital rankings. However, under the ACA, all participating medical facilities have to submit their yearly reports to the DHHS, and that information is about to become much more public on the DHHS’s website, Healthcare.gov

Mandated by the ACA as a source for all public information required under the law, Healthcare.gov provides a page where the public can find comparisons across different types of medical facilities. These comparisons are based on the data provided by hospitals, and are compiled by the DHHS and the Centers for Medicare/Medicaid Innovation. In addition to searching by different types of medical facilities, the public can also find comparisons of individual physicians.

This is good news for patients. Being able to see how their medical providers compare to others will help patients make informed decisions on where to pursue treatment. Informed decisions and higher quality care just naturally translate into a better chance of positive patient outcomes.

This is a mixed bag for the medical facilities and physicians, however. For those who are already doing well, such as Magnet-designated hospitals or specialist physicians doing ground-breaking work, this site will be a boon to business. After all, higher ratings mean a higher census for medical facilities and more patients for a physician.

For those facilities that are struggling, such as inner-city facilities with high rates of indigent or uninsured patients requiring advanced tertiary care, having that information freely available may not help their bottom line. A poor ranking will drive patients away from a facility, and could even cost a facility their federal funding.

This presents a potential catch-22, as a facility that loses funding may no longer be able to keep up with medical innovations, similar to how schools that fall behind under the No Child Left Behind Act often struggle to improve once their funding is taken away. The upside is that the rankings are evaluated every year, and do take demographics into account. A rural hospital in Texas will not be considered the same as a private hospital in Boston, for example.

The take-away message here is that these standards are designed to assist the public in making informed decisions in their medical care by providing comparisons across a wide range of measurements. Whether a facility sees the new requirements as an opportunity to improve or an onus to produce is up to the facility, but the tie to Federal funding means that participation in the program isn’t voluntary for most.

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This is a Guest Post by Katie AndersonKatie Anderson.
Katie blogs at What the Health where she puts the Affordable Care Act into plain English. For more information about Katie and What the Health go to her blog saywhatthehealth.com

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.

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