Our current system of delivering health care has been based on volume of patients seen in the office or volume of admissions for hospital care. The Medicare legacy system always rewarded this model, with little concern for quality of care and without much accounting for the number of medical errors or lack of patient satisfaction.
Accountable Care Organizations are the newest proposed change to a healthcare system that finds itself on the brink of disaster. As part of an ACO, you would see your primary care physician and should you need the services of any other physician, your primary would refer you to a doctor in the ACO and work closely with them to coordinate your health care as a total package. When I first started to investigate ACO's, I have to admit that I thought - "Is this News?" After spending ten years as an Administrator in Cardiology, I hardly thought that the idea of coordinated care was a novel concept.
Patients receiving care in our office were usually referred to us with a specific set of symptoms or pathologies. Chest pain, shortness of breath, high blood pressure, diabetes, etc. If we found our patients on call during hospital rounds, our first order of business was contact with the referring hospital doctor and then with the patients primary physician. We sent and received detailed consult notes and many hours were spent on the phone discussing and coordinating patient care.
We held symposiums for primary care doctors on the latest trends in cardiac care and knew almost all the primary care doctors that served our demographic area. If we didn't know them either personally or by reputation, we made sure that at some point, early in our patient's care, that we visited their office or invited them to a meeting, either with other physicians or as a solo dinner companion.
Any decent physician specialist will make sure that their patients receive continuity of care, so that patients are not treated as a jumble of parts. The idea of a "wholistic" approach to health care is not new, especially in the New York area.
So, ACO's - what's the big deal?
The aim of Accountable Care Organizations is to provide an overall approach to prevention and treatment of disease, while keeping costs in line and in fact, being accountable and rewarded for keeping costs in line. Oh Boy !
Some patients may be totally delighted to have a home base for all their health care needs, but those of us in this business, who are used to anticipating and dissecting the most remote possibilities are not too sure.
Keeping costs low! What does that mean in the long term?
Can we anticipate a time where doctors are rewarded for not providing services? What if the services are diagnostic or essential? Will we determine these factors based on the age and overall health of the patient? Will we discriminate against the emerging patient base of the baby boomers? What if a CT scan will save my life by finding a curable tumor, but the ACO has already met their overall criteria for CT referrals and will suffer financially if they prescribe one for me? I don't know if I am so thrilled with my doctor thinking about the state of my health based on a reward for not treating me!
Let's face it. We are not living in the age of innocence where doctors will run out in twelve feet of snow, black bag in hand, and sit at our bedside until the fever breaks! This is a business of dollars and cents and we are hard pressed to count on the altruistic behavior of our physicians to put our needs ahead of their financial gain. Cynical? Perhaps. But, I don't want to be eighty years old and have someone disconnect my telemetry equipment because I am a financial drain on the healthcare system. Again, the best physicians often discuss treatment options with the elderly, based on their overall satisfaction with their lives and their desire to minimize or maximize treatment. I have seen the Cardiologists in my group have these types of discussions with patients whose conditions were rapidly deteriorating, day after day, and any physician with empathy for his patients will continue to practice in this matter.
Offering a reward for the denial of services is something entirely different. Are we finding ourselves in an age where treatment is decided by the patients IQ, or financial success? Will the financial consideration lead to fewer errors in treatment? I doubt it. We have seen that the number of medical errors are the same in both sophisticated urban areas as they are in more rural ones where treatment options are limited. So, what's the point?
When I am sick or in pain, I know that I want my physician to find out what is wrong with me, by using every tool of the trade. I don't expect that he or she will be a psychic and decide my treatment options based on a sliding scale of financial gain.
Perhaps we need to take a closer look at the extraordinary profits of the insurance carriers and the pharmaceutical companies and ask them to make a little less profit, instead of denying our patients the care and quality of life they deserve.
Accountable Care Organizations are the newest proposed change to a healthcare system that finds itself on the brink of disaster. As part of an ACO, you would see your primary care physician and should you need the services of any other physician, your primary would refer you to a doctor in the ACO and work closely with them to coordinate your health care as a total package. When I first started to investigate ACO's, I have to admit that I thought - "Is this News?" After spending ten years as an Administrator in Cardiology, I hardly thought that the idea of coordinated care was a novel concept.
Patients receiving care in our office were usually referred to us with a specific set of symptoms or pathologies. Chest pain, shortness of breath, high blood pressure, diabetes, etc. If we found our patients on call during hospital rounds, our first order of business was contact with the referring hospital doctor and then with the patients primary physician. We sent and received detailed consult notes and many hours were spent on the phone discussing and coordinating patient care.
We held symposiums for primary care doctors on the latest trends in cardiac care and knew almost all the primary care doctors that served our demographic area. If we didn't know them either personally or by reputation, we made sure that at some point, early in our patient's care, that we visited their office or invited them to a meeting, either with other physicians or as a solo dinner companion.
Any decent physician specialist will make sure that their patients receive continuity of care, so that patients are not treated as a jumble of parts. The idea of a "wholistic" approach to health care is not new, especially in the New York area.
So, ACO's - what's the big deal?
The aim of Accountable Care Organizations is to provide an overall approach to prevention and treatment of disease, while keeping costs in line and in fact, being accountable and rewarded for keeping costs in line. Oh Boy !
Some patients may be totally delighted to have a home base for all their health care needs, but those of us in this business, who are used to anticipating and dissecting the most remote possibilities are not too sure.
Keeping costs low! What does that mean in the long term?
Can we anticipate a time where doctors are rewarded for not providing services? What if the services are diagnostic or essential? Will we determine these factors based on the age and overall health of the patient? Will we discriminate against the emerging patient base of the baby boomers? What if a CT scan will save my life by finding a curable tumor, but the ACO has already met their overall criteria for CT referrals and will suffer financially if they prescribe one for me? I don't know if I am so thrilled with my doctor thinking about the state of my health based on a reward for not treating me!
Let's face it. We are not living in the age of innocence where doctors will run out in twelve feet of snow, black bag in hand, and sit at our bedside until the fever breaks! This is a business of dollars and cents and we are hard pressed to count on the altruistic behavior of our physicians to put our needs ahead of their financial gain. Cynical? Perhaps. But, I don't want to be eighty years old and have someone disconnect my telemetry equipment because I am a financial drain on the healthcare system. Again, the best physicians often discuss treatment options with the elderly, based on their overall satisfaction with their lives and their desire to minimize or maximize treatment. I have seen the Cardiologists in my group have these types of discussions with patients whose conditions were rapidly deteriorating, day after day, and any physician with empathy for his patients will continue to practice in this matter.
Offering a reward for the denial of services is something entirely different. Are we finding ourselves in an age where treatment is decided by the patients IQ, or financial success? Will the financial consideration lead to fewer errors in treatment? I doubt it. We have seen that the number of medical errors are the same in both sophisticated urban areas as they are in more rural ones where treatment options are limited. So, what's the point?
When I am sick or in pain, I know that I want my physician to find out what is wrong with me, by using every tool of the trade. I don't expect that he or she will be a psychic and decide my treatment options based on a sliding scale of financial gain.
Perhaps we need to take a closer look at the extraordinary profits of the insurance carriers and the pharmaceutical companies and ask them to make a little less profit, instead of denying our patients the care and quality of life they deserve.
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