Teachable Moments

The ACA Is a Call to Do Better


By now, anyone who isn't vacationing off the grid in a remote tropical paradise probably knows that the U.S. Supreme Court upheld the Affordable Care Act. Within hours of the court’s announcement, there were already fresh plans underway to repeal the hotly contested health care reform law signed by President Obama in March 2010. Nevertheless, for now, it is law and it will impact millions of patients, as well as the doctors and hospitals that serve them.

In February 2011, Dr. Donald M. Berwick, then Centers for Medicare and Medicaid Services chief, pointed out to the House Committee on Ways and Means that millions of Americans were already benefiting from this law, while many major provisions had not even kicked in yet. While we can all agree that the law is not perfect, what is? Most of us can find something very positive about the ACA.

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Many changes are on the horizon – changes that will impact hospitalists significantly.

One important goal of the ACA is to reduce waste in the system. Although there are various ways by which this is projected to occur, one of the most meaningful for hospitalists is the scrutiny of Hospital-Acquired Conditions (HACs). Under the Affordable Care Act, hospitals whose HAC rate is significantly higher than average will receive reduced payments.

When I first learned about this provision and the financial penalty for excess HACs, I thought it was unreasonable. Can we realistically prevent every catheter-related UTI and pressure ulcer in our patients? No, but through more rigid surveillance, we can dramatically decrease their incidence, and we (and our patients) cannot afford for this to be taken lightly. The Centers for Disease Control and Prevention estimates that 100,000 Americans die from hospital-acquired infections, and millions more suffer, adding tens billions of dollars to hospital costs yearly. Those numbers are staggering!

Another component of the ACA is to link financial incentives to readmission rates, as an estimated 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Although some readmissions may be unpreventable (such as some patients with end-stage chronic obstructive pulmonary disease), others may be preventable. For instance, if patients see their primary care provider (PCP) within a couple of days of discharge, and again soon thereafter, the PCP may be able to spot and treat a downward decline that would otherwise culminate in a readmission.

The teachable moment this time is for hospitalists, more so than for our patients. We have plenty to learn in pursuit of our very best, but with the help of innovative hospital administrators, medical directors, and our own ingenuity, we can make tremendous strides helping the patients whom we serve and improving the U.S. health care system as a whole.

This column, "Teachable Moments," regularly appears in Hospitalist News, an Elsevier publication. Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

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