Accountable care has certainly made some important strides in terms of addressing how physicians are paid for the services they provide, but for accountable care to work fully, we need to change the way healthcare providers practice medicine. Accountable care needs to be framed as accountable medicine – because the only way for the changes proposed by the ACA to take full effect and become sustainable, long term practices is to start at the source and change the way that we practice medicine.
The premise of accountable care seems pretty intuitive when you reflect on how, over the last several decades, the payment method healthcare has been using proved itself unsustainable. If providers could invoice for services, tests and procedures willy-nilly, regardless of whether or not the patient’s health improved, the focus on finances shifted resources and attention away from patient care. Now, through accountable care, patient-centered medical homes and shared risk, we’re attempting to shift the focus back to the roots of medicine – patients.
How medicine evolved to become a business venture is important, though, because it provides a perspective that we need to understand as we move forward in driving attention, resources and finances back into patient care. We need to find innovative yet cost-effective ways to treat patients. We need to do more with less.
Accountable care organizations provide physicians with a set amount of dollars which they need to, essentially, budget for an entire population of patients. This takes into consideration the average cost of treating patients with certain conditions or healthcare needs. By grouping patients this way, the hope is that treatment protocols can be designed that will address the needs of patients within that group for a certain amount of money – and that, if a physician can stick to the budget or even perform under-budget, they’ll be rewarded. Thriftiness is an asset to a physician in this day and age, where technology drives healthcare costs up and so to rise the expectations of the patients.
It’s no longer enough to treat a patient’s condition – the modern physician must do so with technological prowess, a pleasant and compassionate bedside manner and Wall Street money mindfulness. That’s why accountable care organizations propose that physician’s don’t attempt to hoe the row on their own – the shared risk of joining or forming an ACO is in and of itself an incentive, but it’s also a chance for physicians to get together, collaborate on patient care and innovate cost-savings together. When you consider how much time the physician of today spends documenting, working with payers, attending meetings and shouldering administrative tasks, it’s a wonder that they’re able to see patients at all – working as a team, as part of an ACO, may have the feel of a cooperative at first, but it’s no longer possible for healthcare providers to operate in silos. With the baby boomer generation aging into Medicare and patients developing complex chronic illnesses younger and younger, the demand of healthcare is rising, the costs are rising – and the supply of physicians up to the task is dwindling.
ACOs are still new, though, and the true efficacy will only be known with time. Not enough time has elapsed for there to be any true longitudinal surveys of their success, but the initial research does seem to correlate innovative payment models with savings – the number of ACOs in the U.S. has doubled since 2012, so there are more opportunities now to study the efficacy of the program.
Still, hospitals have to commit to making the change. Conversion to an ACO is a multi-step process that requires a lot of forethought, flexibility and creativity. The upfront financial cost of conversion might be a bit of a turn-off, but the potential for savings over time as a benefit seems to outweigh the initial cost of implementing ACOs. Of course, this will be relative to each individual healthcare system – and there’s nothing wrong with asking for help and advice. The reality is, healthcare is changing and everyone needs to start somewhere – how will you begin?
