Regulating Patient Safety: The Patient Protection and Affordable Care Act

Abstract

Patient injury is a predictable feature of health care, particularly in hospitals, in the United States and elsewhere. Analysis of patient safety rests on four basic propositions. First, patient injury (ranging from minor injuries to death) is a recurring feature of health care and negatively affects roughly one in every ten patients. Second, physicians (and the hospitals in which they practice) all too often continue to practice bad medicine in spite of what is known about good medical practice. Third, medical practice too often ignores effective practices. Fourth, regulatory tools need to be expanded in order to force more integration and coordination in health care delivery.

This article examples the range of patient safety efforts undertaken in the U.S. over the past fifteen years, with particular emphasis on the patient safety initiatives in the Patient Protection and Affordable Care Act. Six broad strategies are examined, including 1) Standardizing Good Medical Practices; 2) Tracking Adverse Events in Hospitals; (3) Disclosing Provider Performance; (4) Reforming Payment Systems; (5) Coordinating and Integrating Care; and (6) Expanding Provider Responsibility.

The PPACA is a major attempt to improve access to health care by expanding coverage through Medicaid and by reforming the private insurance market. Quality is also an important focus of PPACA - it promotes disease management, care coordination, new payment models, value-based purchasing initiatives, and the use of comparative effectiveness research. PPACA offers a strong regulatory push toward the goal of “flawless execution,” the health care equivalent of zero defects in industrial production.