Ensuring Quality Through the ACA

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November 2013

Because of politics, people have been focused on the cost health care reform, but I thought you might like to know about other aspects of the legislation, like how it helps ensure high quality care.

The Affordable Care Act (ACA) has many provisions aimed at improving quality and patient safety, not the least of which is that payment for services will be linked to better quality outcomes. In fact, federally funded health centers are required to submit massive amounts of quality data that demonstrate: 1. patients receive the evidence-based treatment they should, and 2. if patients are hospitalized, that the hospitalization was justified.

With the introduction of the electronic health record (EHR), doctors’ offices, health clinics, and hospitals have been able to track patient data like never before. In addition to using patient data to make decisions about how to best care for people, health care providers who receive payments from managed care organizations, as well as county, state, and federal government sources can now prove that their patients are healthier as a result of the care they provide.

Government health organizations use the data in several ways. First, of course, is to make sure that the health care they are funding is of high quality. But also, by collecting data from providers all over the county, state, or nation; governmental organizations can identify health care trends and provide incentives and best practices for addressing those chronic health problems.

The whole premise of the ACA is to shift resources from expensive emergency and end-of-life care to prevention and wellness care. Although the old adage about an ounce of prevention being worth a pound of cure is true, it took the ACA to make it happen in the health care industry.

Chronic diseases are difficult for people to deal with and can be very expensive to treat, especially if they are not managed well. Many chronic diseases are preventable, and the ACA encourages health providers to pay special attention to these areas.

In Mendocino County, we see a lot of patients with diabetes, heart disease, and hypertension (high blood pressure). One of the underlying causes for all of these illnesses is obesity, which is rampant in Mendocino County. Sadly, it is especially prevalent among our youth.

With ACA guidelines encouraging health providers to educate patients about diet, exercise, and other healthy lifestyle habits, patients are less likely to require emergency care for their diseases. For people with diabetes, for example, health providers perform regular Hemoglobin A1c blood tests. If a patient’s results are higher than normal, they are immediately informed and assisted in getting their blood sugar back in check.

If a patient is overweight, their body mass index (BMI) is measured (comparing height to weight) and if the BMI indicates obesity, the health provider provides health education and counseling to assist them in losing weight.

If a patient smokes, they are counseled on quitting and encouraged to take a smoking cessation class.

In addition to poorly managed chronic diseases, end-of-life care can also be expensive and sometimes unwanted. The ACA requires health providers to talk to patients about advance directives, making decisions ahead of time about whether they want emergency care should their health fail. Clearly, most young people want everything possible to be done to save them. However, an elderly cancer patient who only has months to live would probably rather not go through expensive, invasive medical procedures at the very end of his or her life.

Another way the ACA prevents unnecessary emergency care is by making medical screenings free for patients. Some of the free preventive care mandated by the ACA includes screening for high blood pressure, cholesterol, colorectal cancer, breast cancer, diabetes, depression, obesity and more. 

Prevention really will pay for itself. A blood test is much less expensive than having a foot amputated as a result of uncontrolled diabetes. A small cancerous tumor is easier to treat than cancer that has spread throughout the body. Preventive care is great for patients, and much less expensive for everyone.

Many local health and social services providers are now offering free health education, from cooking classes at the Ford Street Project to Diabetes Education at the hospital to Healthy Living Classes at Hillside Health Center. It’s amazing to me that parents would never consider driving unless their small child were strapped into a car seat. Yet, they put their child’s health at risk by feeding them processed junk food. Now that the ACA is funding prevention and wellness, we’ll be able to educate parents so they can care for themselves and their children – again, hopefully preventing the chronic diseases that affect so many people.

Since it’s Breast Cancer Awareness month, I’ll put in a plug for women over 40 (or with a family history of breast cancer) to be sure to get their mammograms. Catching cancer early increases your chances of a full recovery! If you don’t have health insurance, sign up for coverage today. Outreach coordinators at local health centers and at Public Health can help you, or you can visit www.coveredca.com.

Lin Hunter is CEO of Mendocino Community Health Clinic. She has been involved in local health care for 30 years. Contact her with questions or column ideas at lhunter@mchcinc.org.

 

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