One of the main tenets of healthcare reform is a drive to improve care quality, but cuts to Medicare stemming from the Patient Protection and Affordable Care Act may actually have a negative impact on care quality and lead to patient harm, according to a New York Times report by Austin Frakt, PhD, a health economist.
Some studies cited in the report found hospitals tend to respond to revenue cuts by making subsequent cuts to personnel to maintain revenue. When layoffs affect nurses, it can lead to an increase in adverse events, the report states.
Additionally, other hospitals respond to lower Medicare payments by trying to lower length of stays. But shorter length of stays can lead to increased mortality for heart attack and pneumonia patients, according to the report.
"In short, history suggests that hospitals may respond to payment cuts and financial stress in ways that are detrimental to patients, though that is certainly not their intent" Dr. Frakt wrote.
However, many new models of care created by the PPACA are focused on improving quality, like accountable care organizations, that offer bonuses for meeting quality improvement metrics. Also, with more people acquiring health insurance thanks to health reform, hospitals will have to provide less charity care, thus positively impacting their bottom lines, the report notes.