There was an interesting Op-Ed piece in the New York Post on November 22 by Scott Gottlieb. Over the last few months we've been seeing more and more interest in Accountable Care Organizations (ACO). Some are saying this is the answer to controlling healthcare costs; others are saying this will speed up the rising costs of healthcare. At this point the verdict is still out since we are in the early stages of this process. What we do know is that healthcare today is very fragmented and uncoordinated. Ask anyone who has been in the hospital for a period of time and you hear a consistent story. Doctors are highly specialized and don’t talk to each other. A patient may have 3 to 7 different doctors working with a patient and at times they are not on the same page of care coordination. The ACO’s were created to bring sanity to a fragmented process. It looks good on paper, but can you execute on this idea? It will require technology, a willingness on the part of providers to communicate with each other and with members, etc.
It’s important we review the pros and cons of ACO’s. Another excellent piece appeared in the recent Wall Street Journal giving a good balance to both sides of the argument ACO argument. The bottom-line is that the current system is not working, and healthcare delivery must change. The biggest challenge within the ACO’s is determining a fair pricing model for all involved. Also, a rational payment methodology must be incorporated for the participants who go outside the ACO for care. Are ACO’s the answer? Stay tuned.
Yesterday I came across a very interesting news item. It seems that one of my idols, Bill Nye the science guy, was about to speak at an event hosted by the University of Southern California. As news reports have it, as Mr Nye was walking up to the podium to speak and on his way he collapsed. Reports say he is fine but what is so interesting about this story is not that he collapsed, It is that no one ran from the audience to help him. Rather, the students were more interested in updating personal Twitter accounts or Facebook updates. As Alastair Fairbanks, a USC senior is quoted, "nobody went to his aid at the very beginning when he first collapsed — that just perplexed me beyond reason." The student added, "Instead, I saw students texting and updating their Twitter statuses. It was just all a very bizarre evening."
I love technology and it is changing the world but at what point to we step back and say “really?” As this relates to healthcare, I’m hopeful that if I collapse on the way to the hospital, the EMT or doctors would at least check my vital signs to before Tweeting.
A great article appeared in today’s Wall Street Journal written by Anna Wiled Mathews. This highlights the unintended consequences of a healthcare system that is spinning out of control. Employers continue to raise deductibles and coinsurance in order to offset the increases in premium, thus forcing doctors and hospitals to chase more out-of-pocket dollars. Doctor today are not only healthcare providers but financial service companies. Their receivables are at record highs today. It used to be that providers only had to work with insurance companies to collect the fees for their services. Today, they are not only working with the insurance companies to collect they are having to collect a record amount from the patient.
You can’t blame the physicians for saying “enough.” They went to medical school to learn how to provide excellent healthcare, not to chase receivables. As Americans struggle with the increasing costs of healthcare, we will see a more severe price increase in health costs over the next few years. As doctors sell their practices to health systems and take themselves out of the billing nightmare, we are going to create another pricing issue. We will be left with mega systems controlling the pricing structure of healthcare with very little ability to control the pricing structure. With the consolidation of physician practices with facilities, there is worry that we will see an increase in pricing. As Karen Ignagni, CEO of AHIP, stated in the article, "We've always been concerned about combinations that are being done to increase prices." William F. Jessee, CEO of the Medical Group Management Association, said he expected to see "more physicians selling out to hospitals."