A New Quality Compass: Hospital Boards’ Increased Role Under The Affordable Care Act

Abstract

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

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