Up to the minute information for your financial success. 

July 5,s 2011

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PBN's Summer Series: The "So What?" Guide to Changes in Healthcare Regulations and Practice

The Accountable Care Movement 

Defined simply, the Accountable Care Movement is a reflection of a the modern business trend away from a primary focus on sales, market share, and profits, and toward an extreme focus on your customer and "the customer experience"—or in the case of helathcare—your patients and their overall experience when they encounter the healthcare system.    Understanding this movement and making decisions about how you and your practice respond may be critical to your future success.  

Three Primary Accountable Care Movement Drivers

The trend toward accountable care didn't start with the Obama administration.  It's goals transcend politics.  Among many things driving the trend, it's most important to understand these three.  

1. Market Trends . . . Besides the healthcare market moving to finally catching up to today’s general business market trend, two other things are driving the movement.
   
2. CMS Incentives . . . The main driver is CMS with its Accountable Care Organization Incentives program and similar programs like the EHR, PQRS and eRx Programs.  These programs are designed to replace the volume incentive of the fee-for-service model with incentives based on measured efficiency and effectiveness.  They offer financial rewards (and penalties) that amplify the natural business rewards from adopting modern business practices.
   
3. NCQA’s PCMH Program . . . Since the proposed rule creating the CMS ACO program was released earlier this year, it has received so much publicity that you might think it’s the only thing driving the accountable care movement, but there is at least one other significant program. A separate (and converging) movement, started in 2008 by the National Committee for Quality Assurance (NCQA), the Patient-Centered Medical Home (PCMH) model, has very similar goals to the CMS program.  The program’s guidelines were recently updated to “align with” CMS goals for Meaningful Use in adopting healthcare information technology.  Without the benefit of any external financial incentives, studies show positive program outcomes, including measurable improvements in both the quality of patient care and cost savings through adopting its best practice efficiencies.

Getting Past the Hype 

The recent crop of publication-sponsored (or fee-based) seminars aimed at explaining the ACO model and how (or whether) physicians should participate are all over the board in terms of depth and quality of the information offered.  You can find everything from a two-minute "infomercial" style book review whose message is nothing more than “You should be more ’Consumer-centric’” (and “Buy my book to find out how”) to a 1.5 hour seminar that costs as much as $429 to sit in on over the Web (that’s almost $300 an hour!). 

So what?

First, instead of wasting your money to pay for learning more about the movement, take advantage of the excellent free resources (which serve as the basis for most of the information in this article).  These are available from public and not-for-profit organizations including CMS, the NEJM, the AAFP, and the NCQA as well as others (see the footnotes for links). [i] [ii], [iii], [iv]

Second, realize that as a society, if nothing is done about controlling healthcare costs (or raising taxes to cover the costs), healthcare will cost more than the entire amount of all taxes collected (at current tax rates) by 2035.  By 2080, healthcare costs will consume 46% of total GDP.[iv]

Finally, ask yourself what you and your practice might need to do to stay competitive in a changing marketplace and regulatory environment.  Depending on the current state of your business, this might include . . .

A Shift in Focus
Several commentators have pointed out that the most difficult aspect of ACOs for practicing physicians is the shift in focus from that of an independent practitioner serving individual patients to part of an integrated team serving “a defined population of patients.”  As Atul Gawande explains in the June 30 H&HN Daily, “The puzzle we've had is how to control costs while managing and improving quality, not in isolated examples but at a scale large enough to actually lower costs for an entire community.”

 

A Change in Awareness
And it’s not all business and politics.  It also becoming aware of and utilizing the publicly-available effective treatment resources like http://effectivehealthcare.ahrq.gov/index.cfm/research-available-for-comment/

 

Understanding that your practice is already publicly accountable
Ultimately (next month’s Minute will look more closely at this) in the modern world, with highly credible sites on the Internet rating doctors, nurse-practitioners, hospitals, clinics, and yes, even “The Patient Experience” there’s no way to hide from accountability.

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