What the Supreme Court (and You) Won’t Hear About Health Reform

Posted by

Michael Millenson

There’s a reason the pundits and legal poohbahs are prattling on about the “severability” of the individual mandate provision that’s the focus of much-anticipated Supreme Court hearings on health reform constitutionality. That’s because the partisan obloquy about “Obamacare” too often obscures the fact that the Patient Protection and Affordable Care Act is mostly about patient protection and affordable care.

Case in point: the law’s landmark provisions regarding “patient-centeredness.”

Is anyone against patient-centeredness? Those elitists at the Institute of Medicine, drawing on work by suspect Massachusetts liberals at the Picker Institute, defined patient-centeredness back in 2001 when George W. Bush was president, this way: “Care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” The IOM also made patient-centeredness one of six aims for U.S. health care.

Wait. Couldn’t Ron Paul and the Libertarians endorse that same individual-centric definition, which actually has roots in religious teachings? (Hey, the original Tea Party was in Boston.)

If you’re a free-market conservative, patient-centeredness fits the concept of health care as a marketplace filled with consumers and providers. Interestingly, as early as 1974, under another Republican president, those IOM elitists endorsed publishing outcomes measures “so consumers can be informed of the relative effectiveness of various health providers and make their choices accordingly.”

Finally, if you think actual medical care has nothing to do with politics – which makes you normal –  then patient-reported outcome measures, such as physical functioning have a clinical role when reported in standardized formats that can provide feedback about ongoing treatment decisions.

The ACA supports all of these, repeatedly referring to patient-centeredness, patient satisfaction, patient experience of care, patient engagement and shared decision-making in its provisions. Even when the law only uses the more general term “quality measures,” patient-centered assessments are being required when these provisions are turned into regulations.

These ACA patient-centeredness requirements, built on a long history of bipartisan accord, support and supercharge similar efforts in the private sector and represent an unsung transformation of health care. My colleague Juliana Macri and I write about it in a just-published Urban Institute paper sponsored by the Robert Wood Johnson Foundation, entitled, “Will the Affordable Care Act Move Patient-Centeredness to Center Stage?

Well, to center stage of real life, anyway, if not the excited talking heads world of politics.

 Key ACA Provisions Related to Quality Measurement & Reporting: 

Program/Provision

Quality Measurement & Reporting Activity

Measure Development and/or Revision

Data Submission

Public Reporting

Provisions that specify that “patient-centered” measures (a) must be used
SEC. 3005. Quality Reporting for PPS-Exempt Cancer Hospitals (b)

X

X

SEC. 3013. Quality Measure Development (c)

X

SEC. 3022. Medicare Shared Savings Program

X

X

SEC. 3023. National Pilot Program on Payment Bundling

X

X

SEC. 3201. Medicare Advantage Payment

X

X

SEC. 3502. Establishing Community Health Teams to Support the Patient-Centered Medical Home

X

X

SEC. 3503. Medication Management Services in Treatment of Chronic Disease

X

SEC. 4108. Incentives for Prevention of Chronic Diseases in Medicaid

X

SEC. 10202. Incentives for States to Offer Home and Community-Based Services as Long-Term Care Alternative to Nursing Homes

X

Provisions related to quality measurement that DO NOT specify that “patient-centered” measures must be used
SEC. 2701. Adult Health Quality Measures

X

X

X

SEC. 2703. State Option to Provide Health Homes for Enrollees with Chronic Conditions

X

SEC. 3001. Hospital Value-Based Purchasing

X

SEC. 3002. Improvements to the Physician Quality Reporting System (d)

X

SEC. 3004. Quality Reporting for Long-Term Care Hospitals, Inpatient Rehabilitation Hospitals, and Hospice Programs

X

X

SEC. 3011. National Strategy for Quality Improvement in Health Care (e)
SEC. 3014. Quality Measurement (f)
SEC. 3015. Data Collection, Public Reporting

X

X

SEC. 3021. Establishment of Center for Medicare and Medicaid Innovation Within the Centers for Medicare & Medicaid Services (g)
SEC. 3024. Independence at Home Demonstration

X

3 comments

  1. Thanks for Michael Millenson’s thoughtful article. While PPACA has many laudable features, frankly the law as written is rather scary. I’m one of the poor souls who read the entire bill with amendments. As I read it three things hit me in the face. First, it will create a new and astoundingly huge governemnt bureaucracy. Second, PPACA is grossly,and I do mean grossly, underfunded. The CBO just tacked on another trillion dollars or so to the projected cost. That new estimate is way short. And, third, PPACA is more about shifting who pays for health insurance than doing anything new to control health costs, the latter of which is the root cause of why more people do not have health insurance.

  2. One more comment please… Remember that the CBO estimate of the cost of Medicare was low by a factor of eight, meaning that Medicare actually cost eight times the CBO estimate. The CBO’s record on these things is not good. We have another gross miscalculation by the CBO in the offing with PPACA.

  3. Our healthcare woes are driving us to the poor house. Even if this costs more than we can afford now, we are never ever going to be in a better position to afford it if things continue unchanged. So I get it that the cost estimate isn’t accurate – and wasn’t in the past either. But can we say that creating Medicare was a bad idea because the cost estimate was off?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s