Health care reform in 2010: transforming the delivery system to improve quality of care.
OBJECTIVE
Although the American health care system is the most expensive in the world, it delivers inconsistent (and sometimes poor) quality of care. Recent health care legislation contains several delivery system reforms that will attempt to address these issues. We review these programs and discuss the implications for practicing urologists.


METHODS
We evaluated the medical, legal, and public policy literature (both print and electronic) related to contemporary health care reform efforts. We summarized the Patient Protection and Affordable Care Act of 2010 (PPACA) and examined four cost-containment and/or quality-improvement mechanisms related to Medicare payment policy that will be implemented by this recently passed law.


RESULTS
The PPACA will expand health care coverage and promote bundled payment systems, accountable care organizations, and the patient-centered medical home as the vehicles for containing cost and improving health care quality. The legislation will also establish an independent commission to enact cost-containment policy, which may have significant implications in terms of physician reimbursement.


CONCLUSIONS
Although the recent health care legislation broadens coverage for millions of Americans, there are limited data demonstrating the effectiveness of the cost-containment and quality-improvement mechanisms established by this law. Results from recently initiated pilot programs will emerge over the coming years, and it remains to be seen how health care costs and quality will be affected.
Department of Urology, Dow Division of Health Services Research, The University of Michigan, Room 1032B, Michigan House 2301 Commonwealth Blvd., Ann Arbor, MI 48105-2967, USA.
Christopher P
CP
Filson
John M
JM
Hollingsworth
Ted A
TA
Skolarus
J Quentin
JQ
Clemens
Brent K
BK
Hollenbeck
D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000639:trends*; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000639:trends*; D006801:Humans; D008484:Medicaid; D006278:Medicare; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D011787:Quality of Health Care / Q000331:legislation & jurisprudence / Q000639:trends*; D014481:United States