ACOs: It’s Time to Connect Your Healthcare Castles By Nathan Hitzeman, MD As happens in times of uncertainty, medical groups around the country are merging and fortifying their healthcare castles. Most major changes in healthcare follow monetary incentives, and the incentives are about to change. As the Patient Protection and Affordable Care Act (PPACA) rolls out, the melee to maximize Medicare reimbursement in 2012 through Accountable Care Organizations (ACOs) and to capture newly insured patients in 2014 has everyone poised in anticipation of battle.1 Look closely at your organization’s CEO. Can you hear the clinks of their mail under their nicely pressed suits? Have you seen their shields and crossbows hung behind their office doors? Do you see their breath steaming the morning air as they watch their troops erect new medical towers? When you mention the word “Kaiser,” do beads of sweat appear on their foreheads while their hands instinctively clench? Will the battle be won by healthcare organizations which have the highest Tesla MRI or the finest robotic arms to assist in surgery? Will the castle with the most beds and towers and outpatient surgery centers prevail? Accordingly, will patients live and die on the whims of the latest in medical technology? How many castles will it take to make our population healthier? I, for one, am tired of receiving carrier pigeon type messages from the Emergency Departments of other castles or, in some cases, no messages at all. Perhaps it is time we left the Dark Ages of feudalism and enter a Renaissance period of healthcare. How about communication and coordination of care and investing in people for a change? Let’s think “outside the castle.” Writer/
surgeon Atul Gawande notes that two decades ago, Denmark had over 150 hospitals for its 5 million people. But after strengthening the quality of its primary care and targeting expensive hot spots in the community, only half of those hospitals remain today.2 Our CEOs have every right to be scared! Every castle has its faults. I was chagrined recently to see one of our patients get lost between hospital discharge and clinic follow up. Many organizations have home nurses who follow up on recently discharged patients. While the organization I work for has fine nurses who do this job, surprisingly their notes and assessments do not readily reach our EMR. When inquiring when ancillary services would be fully integrated into our EMR, we were told that budgetary constraints are leading to a slower than anticipated rollout. Meanwhile, a new subspecialty building has gone up with cocktail tours of radiology suites showcasing multimillion dollar scanners. The United States is second only to Japan in number of MRI machines per capita.3 I don’t think more scanners will save our country’s healthcare but apparently they do reimburse well! The point is this. All of our organizations have money; it’s just not being optimally spent to maximize patient care outcomes. And while technology driven docs want to see the finest facilities that money can buy, how about returning to a basic fundamental truth: patients do better when they have coordinated, guided care with smooth transitions. They also need adequate face time with their doctors. There needs to be reimbursement incentive for physicians to talk with patients and coordi-
March/April 2011
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