Debating the Affordable Care Act: What About Safety?

ACA safety elements were little known but important, nevertheless.

Becky Turpin is the Director of Home & Community for the National Safety Council.

​Blog - There is a lot of talk about the Affordable Care Act (ACA) right now. Will it stay or will it go? What did it really do for us and how much did it cost us? Much of the conversation is focused on insurance coverage, as this is the area that most affected us as individuals. But while affordable access to care is one of the most important aspects of assuring a healthy nation, there are a variety of other rarely mentioned aspects of the ACA that helped us be a safer nation.

While falls are not a natural part of aging, older adult falls are a leading cause of injury death in the United States. Additionally, falls are a common reason for loss of independence and lower quality of life as we age. Annual Medicare costs for falls average $31.3 billion. One way our nation's safety was enhanced came through the ACA's creation of an option for health systems that serve Medicare patients to become Accountable Care Organizations (ACO) to offer high quality, coordinated care. With better care comes reduced costs, and health systems are able to share in those savings. Choosing to participate as an ACO means tracking and reporting on certain preventive care measures, including fall risk screening for those over age 65.

The CDC recognized that without fall risk screening in primary care, the majority of older adults were unable to identify how to stay safe and independent in their homes. CDC also recognized that most primary care providers, who are not geriatricians, were not routinely screening for fall risk; many did not know how to comprehensively provide this type of assessment. CDC developed the STEADI Toolkit to assist providers in screening older adults for fall risk and recommending appropriate and individualized plans for action.

As more health systems became ACOs, they began looking for opportunities to easily integrate new practices that would help them meet their preventive care metrics. The availability of the STEADI toolkit offered ACOs this opportunity for fall risk screening and we have seen a rapid uptake in STEADI implementation across the U.S. that would have been much slower without the ACA.

Another safety element of the ACA that is rarely discussed is the increased requirements demanded of non-profit hospitals to retain their tax-exempt status. Influential to our safety is the community health needs assessment (CHNA) provision. Every three years, hospitals must work with external community partners to review community health data – not just data about their own patients – to determine the biggest needs in health. Based on this data and community input, hospitals must develop a plan to improve the health of their entire community.

Hospitals are often considered anchor institutions, so deeply rooted in a community that they are a leading employer, a leading consumer of local goods and services and a leading investor (i.e. from small grants to local non-profits to purchaser of large plots of land and building new structures). This stature affords them such economic power that, when focused towards a broader set of community health goals, large impacts can be seen.

As hospitals, local health departments and other community leaders poured through their data and heard what is important to the general community, areas of safety emerged. Many health systems have prioritized prescription drug misuse, alcohol misuse and child safety among other injury prevention topics. With this prioritization comes increased awareness of these issues, increased response within the health system and, perhaps most importantly, an increased investment into the community to comprehensively and coordinately respond.

In these unsung ways, the Affordable Care Act made us a safer country, and as we move forward into the unknown future of the ACA, it's imperative that we keep safety in the conversation about our nation's health.

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