B P1 C6 Impact of Health Care Policy on Quality, Outcomes, and Equity in Cardiovascular Disease Flashcards
_____ is the collection of federal, state, and local statutes and regulations that determine the “rules of the game” in health care.
Health policy
A basic understanding of health policy is crucial for the practicing cardiologist as he or she works to deliver high-quality, cost-efficient care and achieve excellent outcomes for patients. Much of health policy falls into two major “buckets”:
- Coverage and access policy
- Payment and delivery system policy
The primary goal of health insurance is to offer _____ against unexpected illness or injury. Prior studies suggest that CVD is commonly associated with financial hardship.
Financial protection
The ACA expanded access to health insurance in two ways.
First, it created _____, which are online marketplaces that individuals and small businesses can use to compare and purchase insurance plans.
The second major way that the ACA expanded coverage was via ______ expansion. For example, almost half of patients admitted for acute myocardial infarction (AMI) report some level of financial stress.
Similarly, about 45% of patients with atherosclerotic CVD report financial hardship due to their medical bills, particularly among those who lack insurance or have low income. Insurance coverage is therefore a key policy area in cardiovascular medicine. Medicaid is a state-administered health insurance program focused on providing coverage for individuals living in poverty, and covers 76 million beneficiaries, more than half of all births, and 60% of nursing home care nationwide.
Insurance exchanges
Medicaid expansion
The earliest move toward value was _____ reporting. In 2004, a consortium of payers and quality organizations, led by Medicare, created Hospital Compare as the first national public reporting program. While participation was voluntary, hospitals that did not participate experienced a payment reduction, so nearly all hospitals joined the program within a few months of its inception
Public reporting
Payment and Delivery System Policy Overview for Cardiovascular Conditions
Public Reporting
Value-Based Purchasing Programs
Alternative Payment Models
The premise of _____ is that paying hospitals and clinicians more if they deliver higher-quality care, or achieve better patient outcomes, will lead to quality improvement.
Value-Based Purchasing programs
The _____ was a public reporting program established in 2006. It was initially a voluntary system, but transitioned into a payment penalty program in 2011, when physicians and group practices faced negative payment adjustments for failing to report their performance data.
Physician Quality Reporting System (PQRS)
The QPP consists of two “tracks” for clinicians:
(1) Merit-Based Incentive Program (MIPS)
(2) Advanced Alternative Payment Models (APMs)
_____, the default program for practicing clinicians, has four domains: clinical quality measures, measures of electronic medical record use, measures of costs of care, and measures of practice improvement activities (such as using patient portals and participating in quality improvement programs and registries).
MIPS
_____ are models that move beyond the traditional fee-for-service payment structure in order to incent high-value care delivery
APMs
The two most relevant APMs to cardiovascular care include ______ and _____.
Accountable Care Organizations (ACOs)
and
Episode-based or “bundled” payments
_____ are groups of hospitals and clinicians that assume risk for their attributed patients’ quality, clinical outcomes, and total costs of care, typically on an annual basis.
ACOs
Another relevant APM to cardiovascular care is ______, which are currently being tested by Medicare through the Bundled Payments for Care Improvement-Advanced (BPCI-A) program. Bundled payment arrangements are similar to ACOs, except that quality and costs are evaluated for an episode of care, triggered by a hospitalization for a specific condition (e.g., AMI, HF)
Bundled payments
