Topol Asks Sebelius 5 ACA Questions

Eric J. Topol, MD, Kathleen Sebelius, MPA

DisclosuresJun 27, 2013

Improving Hospital Safety

Dr. Topol: George Orwell once said that the hospital is the antechamber to the tomb. That was written decades ago, and unfortunately there's still truth to that today. One in 4 hospital patients in America have a problem with medical mistakes, contract hospital-acquired infections, and experience medication errors. The ACA last year began linking Medicare payments to quality of patient care, offering financial incentives to hospitals that improve patient care. How is this working? Have there been any meaningful care improvements over the past year?
Secretary Sebelius: The ACA includes steps to improve the quality of healthcare and, in so doing, lowers costs for taxpayers and patients. This means avoiding costly mistakes and readmissions, keeping patients healthy, rewarding quality instead of quantity, and creating the health information technology infrastructure that enables new payment and delivery models to work. These reforms and investments will build a healthcare system that will ensure quality care for generations to come.
Already we have made significant progress:

Healthcare Spending Is Slowing

Secretary Sebelius: Medicare spending per beneficiary grew just 0.4% per capita in fiscal year 2012, continuing the pattern of very low growth in 2010 and 2011. Medicaid spending per beneficiary also decreased 0.9% in 2011, compared with 0.6% growth in 2010. Average annual increases in family premiums for employer-sponsored insurance were 6.2% from 2004 to 2008, 5.6% from 2009 to 2012, and 4.5% in 2012 alone.

Health Outcomes Are Improving and Adverse Events Are Decreasing

Secretary Sebelius: Several programs tie Medicare reimbursement for hospitals to their readmission rates, when patients have to come back into the hospital within 30 days of being discharged. Additionally, as part of a new ACA initiative, clinicians at some hospitals have reduced their early elective deliveries to close to zero, meaning fewer at-risk newborns and fewer admissions to the NICU.

Providers Are Engaged

Secretary Sebelius: In 2012, we debuted the Medicare Shared Savings Program and the Pioneer Accountable Care Organization Model. These programs encourage providers to invest in redesigning care for higher-quality and more efficient service delivery, without restricting patients' freedom to go to the Medicare provider of their choice.
Over 250 organizations are participating in Medicare ACOs, serving approximately 4 million, or 8%, of Medicare beneficiaries. As existing ACOs choose to add providers and as more organizations join the program, participation in ACOs is expected to grow. ACOs are estimated to save up to $940 million in the first 4 years.
Dr. Topol: The future of medicine is all about genetic testing and using genetic data to develop new and better treatments for patients. How does genomic medicine figure into the ACA? How is it helping to further personalized medicine for patients?
Secretary Sebelius: All marketplace health plans and many other private plans are required to cover recommended preventive services without charging you a copay or deductible. Genetic counseling and testing for the breast cancer susceptibility gene (BRCA) for women at higher risk for breast cancer is one of the free preventive services for women. Also covered without cost-sharing in many private plans are well-woman visits, where a woman can sit down, talk with her provider, and get the recommended preventive services that are age- and developmentally appropriate.
Dr. Topol: Thank you, Secretary Sebelius.
For more information on how the ACA is changing the practice of medicine, providers may visit Healthcare.gov.
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