What the Supreme Court (and You) Won’t Hear About Health Reform

Michael L. Millenson, President of Health Quality Advisors

There’s a reason the pundits and legal poohbahs are prattling on about the “severability” of the individual mandate provision that’s the focus of much-anticipated Supreme Court hearings on health reform constitutionality. That’s because the partisan obloquy about “Obamacare” too often obscures the fact that the Patient Protection and Affordable Care Act is mostly about patient protection and affordable care.

Case in point: the law’s landmark provisions regarding “patient-centeredness.”

Is anyone against patient-centeredness? Those elitists at the Institute of Medicine, drawing on work by suspect Massachusetts liberals at the Picker Institute, defined patient-centeredness back in 2001 when George W. Bush was president, this way: “Care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” The IOM also made patient-centeredness one of six aims for U.S. health care.

Wait. Couldn’t Ron Paul and the Libertarians endorse that same individual-centric definition, which actually has roots in religious teachings? (Hey, the original Tea Party was in Boston.)

If you’re a free-market conservative, patient-centeredness fits the concept of health care as a marketplace filled with consumers and providers. Interestingly, as early as 1974, under another Republican president, those IOM elitists endorsed publishing outcomes measures “so consumers can be informed of the relative effectiveness of various health providers and make their choices accordingly.”

Finally, if you think actual medical care has nothing to do with politics – which makes you normal – then patient-reported outcome measures, such as physical functioning have a clinical role when reported in standardized formats that can provide feedback about ongoing treatment decisions.

The ACA supports all of these, repeatedly referring to patient-centeredness, patient satisfaction, patient experience of care, patient engagement and shared decision-making in its provisions. Even when the law only uses the more general term “quality measures,” patient-centered assessments are being required when these provisions are turned into regulations.

These ACA patient-centeredness requirements, built on a long history of bipartisan accord, support and supercharge similar efforts in the private sector and represent an unsung transformation of health care. My colleague Juliana Macri and I write about it in a just-published Urban Institute paper sponsored by the Robert Wood Johnson Foundation, entitled, “Will the Affordable Care Act Move Patient-Centeredness to Center Stage?”

Well, to center stage of real life, anyway, if not the excited talking heads world of politics.

Key ACA Provisions Related to Quality Measurement & Reporting:

Program/Provision	Quality Measurement & Reporting Activity
Program/Provision	Measure Development and/or Revision	Data Submission	Public Reporting
*Provisions that specify that “patient-centered”* *measures (a) must be used*
SEC. 3005. Quality Reporting for PPS-Exempt Cancer Hospitals (b)		X	X
SEC. 3013. Quality Measure Development (c)	X
SEC. 3022. Medicare Shared Savings Program		X	X
SEC. 3023. National Pilot Program on Payment Bundling	X	X
SEC. 3201. Medicare Advantage Payment		X	X
SEC. 3502. Establishing Community Health Teams to Support the Patient-Centered Medical Home		X	X
SEC. 3503. Medication Management Services in Treatment of Chronic Disease		X
SEC. 4108. Incentives for Prevention of Chronic Diseases in Medicaid		X
SEC. 10202. Incentives for States to Offer Home and Community-Based Services as Long-Term Care Alternative to Nursing Homes		X
*Provisions related to quality measurement that DO NOT specify that “patient-centered” measures must be used*
SEC. 2701. Adult Health Quality Measures	X	X	X
SEC. 2703. State Option to Provide Health Homes for Enrollees with Chronic Conditions		X
SEC. 3001. Hospital Value-Based Purchasing		X
SEC. 3002. Improvements to the Physician Quality Reporting System (d)		X
SEC. 3004. Quality Reporting for Long-Term Care Hospitals, Inpatient Rehabilitation Hospitals, and Hospice Programs		X	X
SEC. 3011. National Strategy for Quality Improvement in Health Care (e)
SEC. 3014. Quality Measurement (f)
SEC. 3015. Data Collection, Public Reporting		X	X
SEC. 3021. Establishment of Center for Medicare and Medicaid Innovation Within the Centers for Medicare & Medicaid Services (g)
SEC. 3024. Independence at Home Demonstration		X