Controlling Costs While Raising the Quality of Care Under the PPACA
There is no doubt that cost control will be a major component of efforts to overhaul the current healthcare system. These efforts are now only vaguely spelled out in the Patient Protection and Affordable Care Act (PPACA) and include such approaches as the development of accountable care organizations (ACOs), implementation of patient-centered medical homes (PCMH) and utilization of global payment methods (perhaps a new and improved version of capitation). Quality of care will continue to be a driving factor, which incidentally means that pay-for-performance (or value-based purchasing) will be emphasized in payment reform. For example, the PPACA outlines the implementation of the hospital value-based purchasing program with a proposed effective date of October 1, 2012. Acute care hospitals will receive bonus payments for performance in five measures. In the following year, hospitals will also be evaluated utilizing efficiency measures such as Medicare spending per beneficiary in addition to the five core measures.
Similar to the Balanced Budget Act of 1997 (BBA), it is also quite likely that a reduction in physician payment for services may also become necessary (termed "productivity adjustments" in the PPACA). However, while physicians did see a cut in payment during the initial years of the BBA, payment was increased in subsequent years. The report issued by the CMS actuary determined that "projected Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red." It seems that it would be somewhat counterproductive to open up healthcare coverage to additional millions while jeopardizing coverage for others. Another potential impact of cutting payment to physicians, other than its effect on current physician practices, hospitals and Medicare beneficiaries, is fewer physicians entering the field of medicine in the future. Should the proposed payment cuts actually be enacted, it is probable that fewer graduates will commit to practice medicine. This would be very detrimental to healthcare access.
It seems that cutting costs while attempting to improve quality and increase access to care will require extensive creativity and great sacrifice on many fronts. The Rolling Stones said it best - You can't always get what you want. I just hope that as we try very hard as a nation to find the best solution to our healthcare issues we will get what we need.
