What are the priorities in the Affordable Care Act? Certainly expansion of accessibility to care. But in addition, a high priority has been placed on improving the quality of health care. In large part, the focus on quality improvement involves implementation of strategies, recommendations and research on an extensive scope. DOTmed has reported previously on these measures, but those were just the beginning. Changes will continue throughout the upcoming years. Below are quality and workforce measures to be implemented in fiscal year 2010 and 2011.

Quality Improvement

A) A National Strategy on American Health

The Department of Health and Human Services (HHS), will be establishing a national strategy to improve the delivery of health care services, patient health outcomes, and population health. In doing so, HHS will be identifying national priorities for improvement. HHS must consider several factors in the strategy, including what has the greatest potential for improving the health outcomes, efficiency, and patient-centeredness of health care for all populations. Other factors include:

-- Identifying areas in the delivery of health care services that have the potential for rapid improvement in the quality and efficiency of patient care;

--Addressing gaps in quality, efficiency, comparative effectiveness information, and health outcomes measures and data aggregation techniques;

--Addressing the health care provided to patients with high-cost chronic diseases;

-- Improving research and dissemination of strategies and best practices to improve patient safety and reduce medical errors, preventable admissions and readmissions, and health care-associated infections; and

--Reducing health disparities across health disparate populations and geographic areas.

HHS will update the national strategy annually with a review of short- and long-term goals. The initial strategy should be developed by January 1, 2011. By that time, HHS will create a website to make public information available regarding the national priorities for health care quality improvement.

B) Improving Access to Trauma Care Center Services

HHS will be providing funding to states to award grants on promoting universal access to trauma care services provided by trauma centers and trauma-related physician specialties. An appropriation in the amount of $100,000,000 has been set for each of fiscal years 2010 through 2015.

Those entities eligible for a grant would be a public or nonprofit trauma center; a consortium; a safety-net public or nonprofit trauma center or a hospital in an underserved area that seeks to establish new trauma services. Some of the activities a grant recipient would need to carry out are:

--Providing fiscal stability and costs related to having service that is available 24 hours a day, 7 days a week, with priority provided to safety net trauma centers located in urban, border, and rural areas;

--Reducing trauma center overcrowding at specific trauma centers related to throughput of trauma patients;

--Establishing new trauma services in underserved areas;

--Enhancing collaboration between trauma centers and other hospitals and emergency medical services personnel related to trauma service availability;

--Making capital improvements to enhance access and expedite trauma care, including providing helipads and associated safety infrastructure; and

-- Enhancing trauma surge capacity at specific trauma centers.

C) Community-Based Collaborative Care Networks

HHS will be able to award grants to eligible entities to support community-based collaborative care networks. A community-based collaborative care network provides comprehensive coordinated and integrated health care services for low-income populations. The grants are authorized for fiscal years 2011 through 2015.

Grant funds may be used for assisting low-income individuals to access health services; enroll in health coverage programs; and obtain a regular primary care provider or a medical home. Other services can including providing case management and care management; outreach using neighborhood health; providing transportation; and expanding capacity, such as through telehealth, after-hours services or urgent care.

D) Community Health Centers

A Community Health Center Fund will be established and administered through HHS to provide for expanded and sustained national investment in community health centers. Funds are authorized from 2011 through 2015 to be used by HHS for the construction and renovation of community health centers.

E) School-Based Health Centers

HHS will establish a program to award grants to eligible entities to support the operation of school-based health centers. The program is authorized for fiscal years 2010 through 2014.

Facilities and communities that have barriers to primary health care, mental health care and substance abuse prevention services will be given priority in grants. Funds awarded under a grant may be used for equipment, training, management and operations, and salaries of personnel.

F) Nurse-Managed Health Clinics

Finally, HHS will also be able to award grants for the cost of the operation of nurse-managed health clinics. Appropriations are $50,000,000 for the fiscal year 2010 and sums as necessary for fiscal years 2011 through 2014. Those facilities will be eligible if nurses are the major providers of services and at least one advanced practice nurse holds an executive management position within the organizational structure. The clinic will also need to assure HHS that it will continue providing comprehensive primary health care services or wellness services without regard to income or insurance status of the patient for the duration of the grant period.

Workforce-Teaching Health Centers

HHS will be authorized to award grants to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs. The grants will be for a term of up to three years with a maximum award of $500,000. Appropriations authorized for the grants are $25,000,000 for fiscal year 2010, $50,000,000 for fiscal year 2011, $50,000,000 for fiscal year 2012 and beyond.

The funds in the grant will be used for the costs of establishing or expanding a primary care residency training program, including costs associated with curriculum development; recruitment, training and retention of residents and faculty; accreditation by various organizations; faculty salaries during the development phase; and technical assistance as needed.

A teaching health center is defined as one that is a community-based, ambulatory patient care center; and operates a primary care residency program. That includes a federally-qualified health center, a community mental health center, a rural health clinic, a health center operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization.

Other Health Reform News

The website the HHS had been maintaining for information on reform: www.healthreform.gov, has been changed to www.healthcare.gov. The new site has changed focus to provide persons with ability to find and compare health coverage options. Individuals can see what options are available in their state, including those with pre-existing conditions. A new feature added is a link to compare hospitals for quality of care. One can choose several hospitals in an area and see comparisons of quality factors including communication, pain control, information given and cleanliness.