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Patient Protection and Affordable Care Act
Medicare, Medicaid, and Value-Based Purchasing: Linking Payment to Quality Outcomes Under the Medicare Program


 

Sec. 3001 Hospital Value-Based Purchasing Program

 

The Secretary of Health and Human Services must establish a hospital value-based purchasing program.32 Please see the section on Medicare for more information.

 

Sec. 3002 Improvements to the Physician Quality Reporting System

 

The ACA integrates the Physician Quality Reporting System with Electronic Health Records reporting.33 Please see the Medicare section for more information. 

 

Sec. 3003 Improvements to the Physician Feedback Program

 

The Secretary of Health and Human Services must assess claims data in order to provide physicians with reports on their resource utilization.34 Please see the Medicare section for more information.

 

Sec. 3004 Quality Reporting for Long-Term Care Hospitals, Inpatient Rehabilitation Hospitals, and Hospice Programs

 

Long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs must annually report quality data to the Center for Medicare and Medicaid Services. Failure to comply with the quality reporting requirements will result in financial penalties.35 Please see the Medicare section for more information.

 

Sec. 3005 Quality Reporting for PPS-Exempt Cancer Hospitals

 

PPS-exempt cancer hospitals must annually report quality data to the Center for Medicare and Medicaid Services.36 Please see the Medicare section for more information.

 

Sec. 3006 Plans for a Value-Based Purchasing Program for Skilled Nursing Facilities and Home Health Agencies

 

The Secretary of Health and Human Services must create plans for value-based purchasing programs for use by skilled nursing facilities and home health agencies.37 Please see the Medicare section for more information.  

 

Sec. 3007 Value-Based Payment Modifier under the Physician Fee Schedule

 

The Secretary of Health and Human Services must create a payment modifier that will adjust physician payments under the physician fee schedule according to the quality of care rendered during a performance period.38 Please see the Medicare section for more information.

 

Sec. 3008 Payment Adjustment for Conditions Acquired in Hospitals

 

Beginning in the fiscal year of 2015, or later, payments to hospitals for discharges will be reduced to account for hospital-acquired conditions.39 Please see the Medicare section for more information.

 

Footnotes

  • 32. Affordable Care Act §3001; 42 U.S.C. 1395ww(o).
  • 33. Affordable Care Act §3002(d); 42 U.S.C. 1395w-4(m)(7).
  • 34. Affordable Care Act §3003(a); 42 U.S.C. 1395w-4(n).
  • 35. Affordable Care Act §3004(a); 42 U.S.C. 1395ww(m); 3004(b); 42 U.S.C. 1395ww(j); 3004(c); 42 U.S.C. 1395f(i).
  • 36. Affordable Care Act §3005; 42 U.S.C 1395cc.
  • 37. Affordable Care Act §3006.
  • 38. Affordable Care Act §3007; 42 U.S.C. 1395w-4.
  • 39. Affordable Care Act §3008(a); 42 U.S.C. 1395ww(p).