1. Quality, Safety, & Efficiency:
Healthcare Delivery in the Age of the Affordable Care Act
Ricci M. Hayes
HCM310 – Introduction to the U.S. Healthcare System
Colorado State University – Global Campus
Dr. Dawn Tesner
June 15, 2015
Healthcare Reform
Safety
Efficiency
Quality

2. Burwell, the Secretary of Health
and Human Services, noted that
consumers have to shift mindset
and understand their role and
responsibility in prevention
(U.S. Department of HHS, 2014).
Affordable Care Act
The Affordable Care Act (ACA) was impacted by glaring
statistics that U.S. spending outweighs most of industrial
nations, but lags in quality and safety (Davis, Kristof, Squires,
& Schoen, 2014). ACA, signed in 2010 by President Obama,
intends to improve quality and safety, while managing the
burdensome cost of healthcare (Sultz & Young, 2014).
Quality – How is it measured?
Dr. Sanjay (Insider Medicine, 2013) uses a Markov model
coined “QALY” prior to treatment, in order to research the
benefits vs. risks (both to the patient, and in responsible use of
resources) of treatment. The outcomes are considered both with and without intervention; an example in the video is that of a person
requiring treatment for macular degeneration: The question posed is not only the immediate cost for the procedure, but what are the
ultimate costs, not only to the patient, but for the community, in managing the care if no treatment is offered? Use the link to view Dr.
Sanjay’s video: https://www.youtube.com/watch?v=bUay9DV__G0
Access to healthcare
improves quality considerably
through primary care
**Prevention**
(Schoen,Radley,Riley,Lippa,Berenson,Dermody,&Shih,2013).
QALY = Quality Adjusted Life Years
1 QALY = 1 Year in Perfect Health
$$$ Benefit

3. Fee for Service
reimbursement
Procedures =
Revenue
Unnecessary
procedures
**UNSAFE**
Safety: A Quality Subset
ACA includes mandates to streamline care (Sultz & Young, 2014), and many
facilities are scrambling to ensure electronic medical records (EMR) are in
place. The roll out of programs, staff training required, can affect safety…but
often in unintended ways. Grennan (2013) point out that if reporting systems
are not user friendly, or are time consuming, medical staff are less likely to
use them; an estimated less than 10% of errors are captured in such database,
making tracking – and therefore, corrective measures – irrelevant.
image source: digitaula.com
Fee for service (FFS) reimbursement not only sent insurance costs through the roof, but infringed on both quality
and safety (Sultz & Young, 2014; Nickitas, 2015). ACA, in its requirement that healthcare providers and
hospitals show better care for the community population (Sultz & Young, 2014), may indirectly
improve support structures – those shown to most directly affect health outcomes –
such as education, access to healthy food, and adequate housing (Somerville,
Seeff, Hale, & O’Brien, 2015).
“All too often, hospital quality improvement teams attempt to use
such methodologies to fix fundamentally flawed processes of
care…Incremental quality improvement cannot make up for
management inadequacies,” (Grennan, 2013, p.32, para.10).

4. Efficiency and Economics in US Healthcare
“…halfof the 2.9 trillion spent on health care is unnecessary or wasteful,” (Nickitas, 2015, p.158, para.2).
“A healthier and more financially secure middle class is good for
business…[there is] evidence that we’ve bent the costcurve since 2010,”
(U.S. Department of Health and Human Services, 2014).
“The best-positioned organizations, such as Geisinger Health System, Intermountain
Healthcare, and Kaiser Permanente, have spent decades refining their integrated care
delivery models,” (Lineen, 2014, p.317, para.2).
“Those who provide higher value [quality] care receive higher
payments than those who provide lower value [quality] care,”
(CSU Global, 2015).
image source: english4expository.wikispaces.com
Healthcare is a dynamic industry, and those hospitals, clinics, and providers invested in quality and safety outcomes will reap
reimbursement under ACA (Sultz & Young, 2014; Lineen, 2014). No longer can hospitals rely on numbers of patients walking
through the doors to pay the bills, but must reconnoiter and adjust to the community quality mandates of ACA if they intend to remain
financially solvent (Lineen, 2014). Nickitas (2015) quotes Rambur as saying, “…financial incentives shift from doing
more to doing what really matters…” (p.156, para.3). Rambur (Nickitas, 2015) describes a ‘less-is-more/wait-and-see’
approach and encourages nursing academia to include within their programs, a financial management component, so that nurses (best
suited to lead the charge in coordinated care) have a more well-rounded view of the challenges in providing quality, safe care in
an efficientmanner.

5. References
Colorado State University-Global Campus. (2015). Module 6 – Healthcare reform: Impact of external factors on healthcare
service delivery [Schoology ecourse]. In HCM 310 – Introduction to the U.S. healthcare system. Greenwood Village,
CO: Author.
Davis, K., Kristof, S., Squires, D, & Schoen, C. (2014, June). Mirror, mirror on the wall: How the performance of the U.S. health care
system compares internationally. The Common Wealth Fund. Retrieved from
http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf
Grennan, J. (2013). Quality improvement and patient safety in the age of reform: Preconditions for success. Physician Executive,
39(4), 28-37.
Insider Medicine. [SSanjayMD]. (2013, May 14). Health economics [Video file]. Retrieved from
https://www.youtube.com/watch?v=bUay9DV__G0
Lineen, J. (2014). Hospital consolidation: “Safety in numbers” strategy prevails in preparation for a value-based marketplace. Journal
of Healthcare Management, 59(5), 315-317.
Nickitas, D. (2015). Understanding health and payment reform – essential for the new world of nursing: An interview with Betty
Rambur. Nursing Economic$, 41(3), 155-181.
Somerville, M., Seeff, L., Hale, D., & O’Brien, D. (2015). Hospitals, collaboration, and community health improvement. Journal of
Law, Medicine & Ethics, 42(1), 56-59. doi: 10.1111/jlme.12217

6. Sultz, H. & Young, K. (2014). Health care USA: Understanding its organization and delivery (8th edition). Burlington, MA: Jones &
Bartlett Learning, LLC.
U.S. Department of Health and Human Services. (2014, September 25). The Affordable Care Act is working [Video file]. Retrieved
from https://www.youtube.com/watch?v=SB56WXdKBKQ