Feb. 07 2017

Accountability Still Matters

Hospitals are a constant central feature of the healthcare system. But how does their role evolve amidst policy changes?

A major goal of the Affordable Care Act is to improve healthcare quality without raising costs. One way it does this is through Accountable Care Organizations, a network of hospitals, doctors, and other healthcare providers who join together to coordinate care. While Republicans control Washington and promise to dismantle the ACA, a healthcare researcher says hospitals will continue to pursue accountability, even without formal rules in place.

“From a hospital perspective, the current approach is a move towards a model that’s less fee for service and more value capital—that shift was happening regardless of the Affordable Care Act,” says John McHugh, assistant professor in Health Policy and Management. “Both sides of the aisle can see that the fee-for-service model is not sustainable. I think hospital administrators will continue efforts to make care models more efficient, build relationships in the community, make improvements to population health, and create more value within the system.”

With a career background in start-ups, strategic consulting, and now scholarship, McHugh, who joined the Mailman School in September, brings a unique perspective on healthcare management and hospital administration. As part of his doctoral research, McHugh explored the handoff between hospitals and nursing homes—a link key for patients who may no longer be in need of acute hospital care anymore, but do need some care.

Hospitals are financially incentivized to keep length of patient stay down, and now, readmission penalties go one step further, making hospitals responsible for post-discharge care management. For patients well enough to leave the hospital but too sick to be discharged home, skilled nursing facilities (SNFs) fill in this gap from hospital to home, providing a place for patients to receive care for two to four weeks after discharge.

Prior to recent Medicare changes, one in four patients was readmitted to hospitals after being released—a readmission rate that both Medicare and the Affordable Care Act aimed to lower through penalties and other value-based payment models, such as Accountable Care Organizations. Tighter coordination between hospitals and SNFs was expected to result from these measures.

McHugh, together with researchers at Brown University, recently published an analysis of the impact of these reforms on readmission rates. Their findings were positive: comparing annual data between 2007-2013, readmission rates have fallen across the board, and ACOs saw their rates lower by substantially more than non-ACOs—15 percent lower for one type of ACO and 18 percent lower for another, compared to a 13 percent decrease for non-ACOs. 

As legislators continue to debate a potential ACA repeal, it’s clear that the big players within the healthcare industry will be just fine. Consultants—a field McHugh says “is often needed in uncertainty and in times of change”—may even see their opportunities grow. Hospitals and hospital administrators, too, will remain a part of the fabric of healthcare.

However, on the coverage side of the ACA—including the individual mandates, insurance exchanges, ACOs, and more—a repeal will have real impact on patients, especially low-income patients who may lose their health insurance coverage.  

“There will be populations who will be hit hard by an ACA repeal, people and communities that are critical for the field of public health and its students to focus on,” says McHugh. “There’s a real need within the research community to accelerate, look at the incentive programs to understand what’s working, and speak up about them. Make sure voices are heard, that evidence is known and followed, and keep fighting.”