Health affairs
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Hospital Compare, Medicare's public reporting initiative, began reporting measures of hospital quality for almost all US acute care hospitals in 2005. The impact of this public reporting initiative on patient mortality is unknown. ⋯ Our analysis indicates that the fact that hospitals had to report quality data under Hospital Compare led to no reductions in mortality beyond existing trends for heart attack and pneumonia and led to a modest reduction in mortality for heart failure. We conclude that Medicare's public reporting initiative for hospitals has had a minimal impact on patient mortality.
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The Affordable Care Act calls for the establishment of state-level health insurance exchanges. The viability and success of these exchanges will require effective risk-adjustment strategies to compensate for differences in enrollees' health status across health plans. This article describes why the Affordable Care Act could lead to favorable or adverse risk selection across plans. ⋯ We performed a simulation that showed that under the premium rating restrictions in the law, large incentives for insurers to attract healthier enrollees will be likely to persist-resulting in substantial overpayment to plans with very healthy enrollees and underpayment to plans with very sick members. We conclude that risk adjustment based on patients' diagnoses, such as will be in place from 2014 on, will yield payments to insurers that will be more accurate than what will come solely from the age-adjusted and other rating allowed by the act. We also describe additional challenges of implementing risk adjustment.
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The health insurance exchange is the centerpiece of the insurance reforms created by the Affordable Care Act. The Small Business Health Options Program (SHOP) is intended to create a marketplace for small, and perhaps eventually large, employers to purchase health insurance for their employees. ⋯ The paper also describes the difficulties these exchanges will face, as well as the opportunities they will offer to states, employers, and individuals. The success or failure of small-business exchanges may well hinge on how states choose to address these challenges.