Chapter 7
Delivery System Reforms
Overview of Delivery System Reforms
If anything, healthcare reform has proven that it is more than just about accountable care organizations or the insurance mandate. The Affordable Care Act (ACA) successfully weaves together many changes in the way healthcare is delivered, not to mention paid, and the shared savings incentive is but one of the tools available to providers who are able to deliver and report on quality of care in the manner defined by Washington. In one example, as this chapter will show, hospitals that can deliver on clinical care, patient experience of care, and mortality metrics can actually win at the zero-sum game called value-based purchasing. Other changes to the delivery system similarly modify payment without changing delivery, such as the payment reductions for excessive hospital readmissions, hospital-acquired conditions, and market-basket payment adjustments, while the bundled payment pilot programs truly reform the way providers are compensated for the delivery of care. Medicare Payment Advisory Commission (MedPAC) Executive Director Mark Miller, in 2008 testimony before the Senate Finance Committee, said it well:
To increase value for the Medicare program, its beneficiaries, and the taxpayers, we are looking at payment policies that go beyond the current [fee for service] payment system boundaries of scope and time. This new direction would hold providers jointly accountable for the quality of that care and the resources ...
