2013 Year-in-Review: A government shutdown and showdown, Pioneer ACOs exit program and more

It's that time of year again: Eggnog, sugarplums, chestnuts on an open fire and our annual look back at the top stories that dominated this year's FierceHealthcare headlines.

ACA, government shutdown and HealthCare.gov dominate media

The Affordable Care Act--President Barack Obama's signature healthcare reform law--led to a bitter showdown this fall as lawmakers refused to compromise on a spending bill and nearly brought the country to an unprecedented debt default. Republicans used the standoff to try to dismantle or defund healthcare reform and Democrats wouldn't allow it to become a bargaining chip. The result: A 16-day partial government shutdown that put 800,000 federal employees out of work and health initiatives in jeopardy.

The shutdown began on Oct. 1, the same day federal and state health insurance exchanges opened to enroll uninsured Americans into insurance plans as part of the ACA. It wasn't until the shutdown was over and the bickering between lawmakers began to settle down that the media understood the extent of the troubled rollout of the federal HealthCare.gov website.

The technical glitches that plagued the website, blame over who was at fault and worry over potential security breaches gave Republicans more ammunition against the ACA. Meanwhile, President Obama's approval rating dropped following his apology in November to millions of Americans who have received insurance plan cancellations as a result of the ACA, despite his assurances while promoting the benefits of the law that no one would lose their insurance.

It's still unclear whether Americans will overlook the troubles so that the White House administration can meets its goal of having 7 million uninsured signed up for private insurance through the exchanges when the open enrollment period ends in March 2014.

Nine Pioneer ACOs exit program

Despite promising results from CMS' Pioneer accountable care initiative nine of the 32 ACOs left the experimental program in July, the first year of the program, calling into question the future of the program. Seven did not produce savings and announced plans to apply to the alternative ACO model, the Medicare Shared Savings Program.Two others left the program completely.

Meanwhile, just this week CMS announced it is seeking information on the evolution of its ACO initiatives. It wants input on the second round of applications for the current Pioneer ACO model and new ACO models that encourage greater care integration and financial accountability. 

Readmission penalties and reduction efforts a focus

In August, we learned that two-thirds of the nation's hospitals were hit with fines in the second round of Medicare's readmission penalties.The penalties meant that 2,225 of the nation's 5,700 hospitals experienced payment reductions totaling $227 million beginning Oct. 1. Of those hospitals, 18 hospitals lost 2 percent of Medicare reimbursements, the top penalty, while 154 lost1 percent or more.

The threat of payment reductions forced hospitals to seek innovative ways to prevent readmissions. Successful initiatives include the use of "homeless navigators" to help indigent patients find housing or treatment centers after discharge instead of returning to the emergency room, additional nursing staffing and a hospital-community collaborative.

Disasters, terrorist attacks and violence put hospitals to the test

Hospitals this year responded to natural disasters, terrorist attacks and violence within their own facilities. The Boston marathon bombings forced city hospitals to activate their mass casualty and emergency response plans. In the wake of the attack, hospitals across the country conducted emergency training drills to prepare for the worst kinds of disaster and a sudden influx of trauma patients.

In response, the U.S. Department of Health & Human Services awarded nearly $332 million to states, territories and large cities to help hospitals and health systems improve surge capacity and better prepare for public health emergencies. 

Hospitals also faced increasing threats and violence against patients and staff this year. Recent federal statistics indicate that nurses, doctors and mental health professionals are more likely to be assaulted on the job than any other workers. As a result, hospitals are implementing new safety protocols, active-shooter guidelines, mobile duress systems and extra layers of security.

Medical errors become a leading cause of death

Medical errors leading to patient death are much higher than previously thought and may be as high as 400,000 deaths a year, according to a September study in the Journal of Patient Safety. Researchers found that each year preventable adverse events lead to the death of 210,000-400,000 patients who seek care at a hospital. Those figures, according to the Centers for Disease Control and Prevention statistics, make medical errors the third leading cause of death behind heart disease and cancer 

In addition to taking steps to prevent these errors, hospitals can help surgeons get through the emotional trauma they frequently experience after surgical complications by offering additional surgical training, mentoring and psychological interventions.

We'll take a look at what's ahead for the healthcare industry in 2014 when we return from our publisher's holiday on January 2. Until then, I wish you all the happiest of holidays and a healthy and prosperous New Year. - Ilene (@FierceHealth)

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