Governments unlikely to act on health care reform without public pressure

The news headline said it best — Governments unlikely to act on health care reform without public pressure

Although this headline is from The Canadian Press, it could just as easily been a headline about US healthcare reform.

The Centers for Medicare & Medicaid Services (CMS) recently announced initiatives designed to help health care providers improve health care for Americans with Medicare by becoming Accountable Care Organizations (ACOs). According to CMS, these initiatives will improve patient care and save up to $430 million in costs over three years.

So, what is an ACO?

In broad outline, these entities propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO’s bottom line.

Better care with less expenditure … sounds like a great proposition!

Well-known and respected healthcare providers like Cleveland Clinic, the Mayo Clinic, Intermountain Healthcare and the Geisinger Health System have often been singled out as providers who best model an ACO and the first to become ACOs. However, these providers have expressed reservations about the ACO rules that “they doubt that they will participate”:

Mayo Clinic (Patricia Simmons, medical director of government relations): “We think the principles and concepts are very good and very important and we’ve worked long and hard to provide accountable care. Are we interested? Absolutely. But is it feasible? There’d have to be substantial revisions for us to participate.”

Cleveland Clinic (Oliver Henkle, chief government relations officer): “The assumption has been that Cleveland Clinics of the world are ideally suited for this. We are very supportive of the idea. It’s clearly the right way to go and the journey is a good one. But it’s a matter of recommending ways in which we think CMS can make the ACO model and its structure better. The current proposal contains a long list of barriers that clinic officials believe need to be reconsidered.”

Geisinger Health System (Thomas Graf, chairman Community Practice Service): “The concept of the ACO program is certainly sound: the idea of improving quality while reducing cost. It’s the regulations themselves that many organizations have a large number of concerns with. A lot of the detail-level work is problematic. It seems to be very prescriptive and restrictive with a fair amount of administrative and regulatory oversight.”

While there have been many who have commented on ACOs and its proposed rules — they compose the usual array of politicians and organizations — one voice is lacking from the discussion: Patients!

As Jonathan Blum, Deputy Administrator & Director, of CMS said, “Some of the biggest concerns arising from proposed accountable care organization rules may end up coming from patients and not healthcare providers.”

Without a patient voice, the consequences may be best portrayed in the above cartoon, which has perhaps appropriately been dubbed “screwed”.

One Response to “Governments unlikely to act on health care reform without public pressure”
  1. Dial Doctors says:

    I completely agree that patients will have to revolt before changes are made. However, it’s important to specify that the hospitals which have been considered models are probably not making ends meet anyway. It’s easy to dub hospital officials as the knights of the troops against available health care. I believe all hospitals do want the best for as many patients as possible while returning a profit. Wanting to make money isn’t a crime because they have to pay doctors, nurses, equipment and overall staff.

    Their request for a different set of rules is not irrational. When the government meets them halfway, the people may revolt against who is left blocking the way.

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