Over the past decade, there has been a series of national initiatives to improve the quality of care that people in the United States receive, many of which originated from the passage of the Affordable Care Act in 2010. However, the evidence to date suggests these efforts have had limited beneficial effects in the Medicare population. Key programs, such as the Hospital Value-Based Purchasing Program, the Physician Quality Payment Program, and the US Hospital Acquired Condition Reduction Program, have not improved patient outcomes. The Hospital Readmissions Reduction Program initially seemed to have reduced hospital readmissions, but more recent studies suggest that much of the gains may be due to changes in coding, not changes in clinical practice, and it remains controversial.1 Furthermore, some studies have raised concerns that the policy may be associated with higher mortality rates as hospitals aimed to decrease readmissions among patients who have illnesses that may need the care, although other studies have not demonstrated an association between the policy and mortality.2-4 Two other major efforts, the program on accountable care organizations (ACOs) and bundled payments, have shown promise on reducing costs, but neither has had large effects on quality.5 Nearly a decade after the Affordable Care Act, the evidence is in and is sobering. It is time to leverage the evidence to take a fresh approach to improving the quality of care for patients in the United States.
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Figueroa JF, Horneffer KE, Jha AK. Disappointment in the Value-Based Era: Time for a Fresh Approach? JAMA. 2019;322(17):1649–1650. doi:10.1001/jama.2019.15918
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