Healthcare reform and quality: Providers vs. policymakers

With the Supreme Court’s recent decision to uphold the healthcare reform legislation, I thought I would look back on what I wrote in this column in July 2010 about the legislation’s potential impact. My basic premise was that, despite some of the politically charged issues surrounding this topic, the legislation’s primary impact was to improve quality by improving access. Here is an excerpt from that column:

As I prepared a recent presentation on the affect healthcare reform will have on hospital and physician quality for a physician retreat, I realized that to understand this issue, we needed to understand the difference between how the policymakers view quality and how providers view quality. When I asked the physicians in the audience of their definition of quality care, underlying the physicians’ responses was the perception that quality is based on what they do, so it starts when the patient arrives.

But how do policymakers view healthcare quality? In its 2001 book Crossing the Quality Chasm, The Institute of Medicine set six components for quality care:

• Safe: Avoiding injuries
• Effective: Evidenced based to achieve benefits and avoid over and under use
• Patient-centered: Respect and responsive to individual patient needs and preferences
• Efficient: Avoiding waste
• Timely: Reducing delays harmful to those who receive and give care
• Equitable: No variation in quality based on personal characteristics

The key to this framework is that improving quality from a population-based perspective is somewhat different than from a provider’s perspective. The most important component is that care must be timely and equitable. In other words, access to care is a fundamental component to quality from the policy perspective because a lack of care or delayed care is poor quality. Before physicians ever touch the patient, from the public policy perspective, quality starts with patients having timely access.

Clearly, some healthcare reform initiatives are related to the quality of care physicians provide, such as:

• Increasing measurement and data transparency of processes and outcomes
• Reducing waste though appropriate care
• Using evidence-based medicine to improve outcomes
• Eliminating preventable outcomes

Although initiatives related to the care that physicians render are critical, I believe policymakers have put the greatest emphasis on improving access. Plans to increase insurance coverage have received most of the attention, but plans also exist to increase the number of primary care providers by reducing the cost of medical education, offering payment incentives, flexible use of resident training program slots, and various delivery system models.

As providers of care, whether as individuals or as organizations, our quality programs must not only raise the level of care we currently provide, but also address how we can meet the goal of increasing overall access for the patients who will now be able to seek our help.

Did I get it right? Based at least on President Obama’s comments after the decision was rendered, I feel that access is still the key element of this act. I have no crystal ball to determine whether the results of the upcoming election will change some or much of this legislation, but I do believe that access to care has definitively moved up on the quality agenda.  

Robert J. Marder, MD, is practice director of medical staff services for The Greeley Company.

Editor’s note: Questions abound about the Supreme Court ruling to uphold the Patient Protection and Affordable Care Act and how it will affect various parts of healthcare. From a medical staff perspective, as more Americans have access to healthcare, how will facilities cope with the influx of patients? Credential more physicians? Skip steps in the credentialing process to get physicians onboarded faster? Privilege more nonphysicians? The question of measuring competency also comes into play. While we don’t have any answers yet, over the next few months, we will explore some of these topics in Medical Staff Leader Connection and Medical Staff Briefings. Stay tuned.