The Affordable Care Act of 2010 promotes a clinically integrated, systems-based approach to health care. This means coordinating a patient's care over time and across all conditions, diseases, providers, and care settings. The aim is to achieve optimal results in terms of the overall quality of care as well as its efficiency, cost, safety, and timeliness. Hospital boards, which are legally accountable for the quality of the care their institutions provide, need to develop and implement effective quality oversight processes to achieve these objectives. Boards will have to focus less on the competence of individual providers and more on the functioning of the entire system of inpatient and outpatient care. We discuss the increased role of the boards in a systems-based approach to quality, and what steps they can take to meet the quality mandates of the Affordable Care Act.T he Affordable Care Act of 2010 creates a new framework for the delivery of health care in the United States.1 The act adopts a comprehensive national strategy for quality improvement in health care whose foundation is clinically integrated, systems-based practice. Clinical integration means that independent providers such as hospitals or health systems, physician practices, individual providers, and outpatient diagnostic centers integrate their services through shared electronic health record systems, clinical guidelines, unified practice management, and other techniques. In optimal systems-based care, each patient's health care needs are evaluated and treated comprehensively as part of a "system" of care for that person.The result is patient care that is coordinated across all conditions, diseases, providers, and care settings, and over time. The goal is to achieve optimal results in terms of efficiency, cost, safety, and timing, as well as overall quality of care. New Programs In The Affordable Care ActThe act expands existing programs and creates a host of new mandatory programs and voluntary demonstration projects that promote clinically integrated, systems-based practice. The goal is to direct federal health care dollars toward improving the quality and efficiency of care."Never Events" "Never events" is the colloquial term used to describe hospital-acquired conditions-those that patients develop during the course of hospital care, such as pressure ulcers and postsurgical infections-that the Centers for Medicare and Medicaid Services (CMS) has deemed to be avoidable in most cases through the exercise of reasonable care. The never-events payment policy that CMS initiated in 2008 as the result of a legislative mandate included in the Deficit Reduction Act of 2005 defines never events for which CMS will not pay providers.2 CMS's policy-along with similar policies adopted by commercial payers 3 and by state governments, using a range of different mechanisms such as statutes, 4 regulations, 5
Increasingly, medical peer-review organizations are entering into contracts with insurance companies and self-insured employers to conduct utilization reviews and quality-of-care assessments. Such private review activities raise new legal issues, requiring analysis of state law as well as federal law. This paper analyzes several of the most important of these legal issues, and suggests some directions for peer-review organizations to take in order to avoid unnecessary legal problems.
This paper highlights for the nursing education community selected data from a recently completed study of the organization and governance of academic health centers, conducted under the auspices of the Association of Academic Health Centers and funded by the W.K. Kellogg Foundation. It is hoped that the limited information presented here will stimulate interest in the larger study. Presented and discussed are data derived from three different questionnaires used in the study. Top administrators in academic health centers were surveyed in order to produce information on the structural components and hierarchical relationships in contemporary academic health centers, the processes by which decisions are made and conflicts are resolved, and the conditions which administrators envision for their institutions in the future. Deans of nursing schools were part of the survey group, and their responses are examined along with those of deans of other health professional schools.
The degree of confidentiality to be accorded data gathered and analyzed by Professional Standards Review Organizations (PSROs) in the course of their medical peer review activities is a crucial and controversial issue in health policy. In late 1977, a consumer organization in Washington, D.C. sought access to data in the hands of the local PSRO through a lawsuit under the Freedom of Information Act, touching off a continuing debate throughout the country. That lawsuit is now on appeal. The courts, the Congress, and the Department of Health and Human Services have all been involved in the ongoing controversy. PSROs, practicing physicians, and health care consumers all have an interest in the outcome. This article analyzes the PSRO Program and its data confidentiality problems, examines in detail the lawsuit that sparked the controversy, and assesses the overall impact of this case on the PSRO program and on federal regulation of the health care system in general.
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