Navigation Links
Health care organizations quest for reduced costs and improved quality
Date:8/2/2012

Rochester, MN, August 2, 2012 Many health care systems across the US have declined to participate in the Centers for Medicare and Medicaid Services' (CMMS) Accountable Care Organization (ACO) program, developed under the Patient Protection and Affordable Care Act (PPACA), to improve efficiency and quality of health care delivery. In a groundbreaking collection of commentaries in the current issue of Mayo Clinic Proceedings, representatives of six leading health care organizations write about the challenges of reducing health care costs while improving health care quality. They further explain why they did or did not choose to participate in one of the two models now operational at CMMS.

"The US Supreme Court's decision upholding the constitutionality of the Patient Protection and Affordable Care Act provides some security for the fates of the Medicare ACO programs and the private sector's parallel initiatives although political rally cries for repeal of the Act continue to be raised in the build-up to the 2012 election," comments David Ballard, MD, MSPH, PhD, Baylor Health Care System, Dallas, TX, Health Care Policy Section Editor for the journal. "Regardless of the ultimate outcome, we should not ignore the current opportunity to learn from these activities and health care organizations' experiences implementing (or not implementing) them. Such study can inform future national and global economic initiatives aimed at lessening health care costs and waste and improving health care value."

The debate over the PPACA has focused primarily on individual coverage, but experts believe that the most critical issue in health care is delivery system reform. "To put it simply, effective access for tens of millions of Americans is at risk not to mention most other public priorities and middle class jobs in a global economy if we fail to improve the efficiency with which high-quality care is delivered," says Len M. Nichols, PhD, of the Center for Health Policy Research and Ethics, George M. Mason University, Fairfax, VA, a contributor to the special report.

ACOs are groups of physicians, hospitals, and other health care providers that are willing to assume responsibility for the care of a clearly defined population of Medicare beneficiaries. If an ACO succeeds in improving care and reducing costs, they receive a share in the savings achieved for Medicare. The CMMS created two ACO programs, the Pioneer Model, with 32 registered organizations, and the Medicare Shared Savings Program (MSSP), with 27 registered organizations. The basic difference is that the Pioneer program has a greater degree of financial risk and reward. "Many highly regarded health systems developed concerns after initial enthusiasm about the MSSP ACO model as a mechanism for accelerating their efforts to reduce costs while improving health care quality," notes Dr. Ballard.

Robert G. Porter, JD, MBA, and Amanda P. Tosto, RN, MS, of St. Louis-based SSM Health Care, consider the lack of beneficiary engagement in the CMMS ACO models to be a serious design flaw in the program. "The rule provides for invisible enrollment, meaning each beneficiary is enrolled on the basis of their claims history without regard for their actual preferences. This type of enrollment isn't consistent with SSMSL's transition to a patient-centered model of care that is based on the development of a transparent partnership among health care professionals, patients, and their families to ensure that decisions respect the patient's wants, needs, and preferences," they say.

Baylor Health Care System would like to file for Medicare Shared Savings ACO designation, but cannot. The program requires patient attribution via the tax identification number of the physician. Many of Baylor's physicians practice in groups that include non-Baylor physicians, with the entire group sharing a single tax ID. Therefore, Baylor would become financially responsible for the patients of physicians who are not part of the ACO. Health Choice, LLC, in Memphis, TN, had concerns about retrospective patient attribution and administrative complexity.

In contrast, the Atlantic Health System has already begun to see benefits from the formation of its ACO. Author David J. Shulkin, MD, of the Morristown Medical Center and Atlantic Health System ACO, Morristown, NJ, explains that in New Jersey's fragmented health system, patients have a 25% greater chance of staying in an intensive care unit and 75% greater use of specialists than the national average. "New Jersey needed a catalyst for change," Dr. Shulkin notes, "and the MSSP presented us with just that option."

The Atlantic Health ACO consists of four geographically based pods, each consisting of a hospital, physicians, and other community-based organizations in the region. Clinical navigators collaborate with primary care physicians to identify patients with short- and long-term care needs and guide them through planned pathways of care. Sixteen "Centers of Excellence" incorporate multidisciplinary approaches to care management. The Cardiac Success program has achieved 4% to 6% 30-day all-cause readmission rates, compared to the national average of 20-25%, by incorporating protocol-based approaches. "Little by little, New Jersey's fragmented health care system is being replaced with coordination and integration," Dr. Shulkin says.

Ascension Health will use its two Pioneer ACOs, Seton Health Alliance ACO and Genesys Physician Hospital Organization, to teach the rest of its large system about both medical and financial management as well as strategies for engaging physicians around values and shared business goals. Creagh E. Milford, DO, and Timothy G. Ferris, MD, MPH, of Partners HealthCare in Boston, MA, cite key differences from the health care reforms of the 1990s that influenced the decision to participate as a Pioneer ACO, including the preservation of patient choice and improved technology and electronic health records.

Dr. Nichols comments that none of the organizations represented in this special report think that the goals of the PPACA or the ACO experiments are misguided, and in fact there is a groundswell of parallel incentive realignments in the private sector as well. For example, Baylor has formed the Baylor Quality Alliance to develop a clinically integrated delivery organization, and is creating disease-management, population-management care delivery protocols and pathways. The BQA expects to sign an ACO contract with the Baylor Health Center System Employee Benefit Plan, and is in discussions with several Medicare Advantage plans and commercial plans.

In an interview with Dr. Ballard, Carl E. Couch, MD, MMM, of Baylor Health Care System, notes that the recent Supreme Court ruling on the PPACA confirms that the country is headed in this direction. "Regardless of the decision and the potential political implications this fall in terms of sustaining or overthrowing the act, the fundamental problems remain. Health care still costs too much and the trajectory of the costs is unsustainable. And we still have serious quality problems that can be best addressed by physicians and hospitals committing themselves in an accountable way to improve them. We have the same work to do whether the law is here or not."


'/>"/>
Contact: Rachael Zaleski
rachael.zaleski@elsevier.com
215-239-3658
Elsevier
Source:Eurekalert

Related medicine news :

1. Modest Weight Loss Can Reap Prolonged Health Benefits
2. Studying couples to improve health, better relationships
3. Global health researchers urge integrating de-worming into HIV care in Africa
4. Workers With Paid Sick Days Healthier, More Productive: Study
5. Study identifies barriers to breast health care in Pakistan
6. Improving the oral health of adults with special needs proves challenging
7. More Americans Have at Least 2 Chronic Health Issues: CDC
8. Health coaches could be key to successful weight loss, study suggests
9. Mayo Clinic Health System receives grant to improve rural health care
10. Landmark HIV treatment-as-prevention study shows additional health benefits, cost-effectiveness
11. Telephone therapy technique brings more Iraq and Afghanistan veterans into mental health treatment
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/24/2017)... , ... May 24, 2017 , ... ... implants in Bayside, NY, who have now spent 10 years as clinical instructors ... York University (NYU) College of Dentistry. Through the program, private practitioners receive cutting-edge ...
(Date:5/24/2017)... NV (PRWEB) , ... May 24, 2017 , ... ... NV, recently completed Course II of the HP3 (High-Performance Periodontal Practice) continuing education ... to learning the latest advancements in his field by attending numerous CE courses ...
(Date:5/24/2017)... ... May 24, 2017 , ... ... offering holistic pediatric dentistry options for its patients on Long Island, New York. ... entire physical well being, and is one of the biggest trends in dentistry ...
(Date:5/24/2017)... ... May 24, 2017 , ... ... sleep diagnostics sensors, announced today it had completed the first phase of building ... of domestic and rest of world (ROW) authorized dealers specializing in polysomnography accessories. ...
(Date:5/23/2017)... (PRWEB) , ... May 23, 2017 , ... ... in North Carolina have remained steady since 2009, according to a Workers Compensation ... , The study Monitoring the North Carolina System: CompScope™ Benchmarks, 17th Edition ...
Breaking Medicine News(10 mins):
(Date:5/10/2017)... 2017 Global Health Intelligence (GHI), the ... , published its 2017 ranking of the Best-Equipped ... extensive data analysis from GHI,s hospitals database for Latin ... the region. The GHI database covers 86% of the hospitals ... 130 data points for each institution in key areas such ...
(Date:5/10/2017)... Ill. , May 10, 2017 Radiology ... today; unfortunately its costs have also spiraled to the ... being sent to radiology than ever before as the ... diagnosis.  For a patient with lower back pain an ... no anatomical reason for pain, resulting in entirely different ...
(Date:5/9/2017)... Ind. , May 9, 2017 Zimmer ... leader in musculoskeletal healthcare, today announced it has earned ... Employers of 2017" list. The Company was ranked among ... of Large Employers and Healthcare Equipment and Services. ... employers based on an anonymous, independent survey of over ...
Breaking Medicine Technology: