Amidst the uncertainty, delays, and administration of the Affordable Care Act (ACA), a valid question remains as to the reimbursement effects on hospitals nationwide. Given the outreach of the plan to assist in providing insurance to millions who currently can’t afford coverage, a quick assessment would assume an increase in reimbursements to hospitals.

A closer look at the plan reveals a less clear picture of expected reimbursement.

Despite the uncertainty in the industry, one fact is clear: Hospitals will exist in a world where they are rewarded more for quality of care than the volume of patients treated. Through this transition, hospitals must operate within two plans — one where they still earn money per procedure and another that views the treatment of patients with successful outcomes the most important measure of a hospital's performance. The ACA will offer financial incentives to hospitals that perform well. The government determines good performance through a combination of clinical outcomes and patient satisfaction surveys. The ACA will penalize hospitals that appear to perform poorly. The government has already started cutting Medicare reimbursement for hospitals with readmission rates considered excessive. In 2015, hospitals that have high rates of hospital-acquired infections will see a further reimbursement rate cut.

The aforementioned variables surrounding reimbursements make it nearly impossible to derive a true revenue picture for hospitals nationwide, and there will not be a straight-line comparison from one hospital to the next. In summary, it is still too early to know the long term revenue impact to hospitals for the Affordable Care Act.