This notice with comment describes the overall Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an Exchange. The purpose of this notice is to solicit comments on the list of proposed QRS quality measures that QHP issuers would be required to collect and report, the hierarchical structure of the measure sets and the elements of the QRS rating methodology. In addition, this notice solicits comments on ways to ensure the integrity of QRS ratings, and on priority areas for future QRS measure enhancement and development.
Federal Register | Patient Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating System (QRS), Framework Measures and MethodologyNovember 25, 2013
The bottom line: Defensive business arrangements designed to blunt ObamaCare\’s economic impacts will mean less patient choice.
A new analysis from the Clayton Christensen Institute outlines the way many aspects of Obamacare discourage the sort of disruptive innovation that makes previously pricey and complicated products more accessible to more people. For instance, the highly regulated exchanges “essentially put a floor on the low end of coverage, thus limiting opportunities for entrants to provide different types of coverage and methods of care delivery.”Obamacare’s operating system might be fixable; its faulty economic logic surely isn’t.
Last year, a provision of the Affordable Care Act went into effect that puts the nation’s roughly 3,400 acute-care hospitals at risk of getting penalized for excess readmissions of Medicare patients. The maximum penalty is 1% of a hospital’s base Medicare payment, but that will increase to 2% on Oct. 1 and go up to 3% by fiscal 2015. The penalties are based on the number of patients above the national average who are admitted to an acute-care hospital due to heart failure, heart attack or pneumonia and then readmitted within 30 days.
President Obama promised to mend the failings in the American health-care system, and yet for cancer treatment, ObamaCare is taking a rotten feature of the old system and making it worse.The Affordable Care Act expands a program called 340B, which siphons money from drug makers and insurers to subsidize certain hospitals. The program has been expanded as a way to offset some of the cuts that the law imposes on hospitals. One significant side effect: 340B is increasing the cost of cancer care—and harming its quality.When the program began in 1992, its aim was to support hospitals that cared for many uninsured, indigent patients. Over the years, the program was radically broadened, gradually morphing into a government cash cow that hospitals of every description have learned to exploit.
Lowering health-care costs is tougher than improving the quality of care, according to first-year results from a key pilot program under the federal health law.
All of the 32 health systems in the so-called Pioneer Accountable Care Organization program improved patient care on quality measures such as cancer screenings and controlling blood pressure, according to data to be released Tuesday by the Centers for Medicare and Medicaid Services. But only 18 of the 32 managed to lower costs for the Medicare patients they treated—a major goal of the effort.
But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.