There's an interesting Opinion/Editorial piece in today's Wall Street Journal that illustrates the difficulty that the healthcare industry is having embracing the proposed rules for the Medicare Accountable Care Program under last year's health care reform legislation.
Some of the most clinically-integrated health systems in the nation were pilot sites for the new accountable care methods. Essentially every one of them has since stated the current design of the program is unworkable. One of the reasons for this is the fact that doctors and hospitals who are to be held accountable for patient outcomes will not even know which patients for whom they are accountable:
"Incredibly, the ACO teams won't know in advance which patients they're supposed to manage. Seniors will be "retrospectively assigned" to an ACO at the end of every year, based on an arbitrary algorithm, for the purposes of calculating costs."
"Think about that one: The Geisinger [Health System] model works because Geisinger patients are treated by Geisinger physicians. Yet this rule is written to ensure that seniors can take "advantage of the full range of benefits to which they are entitled under the Medicare FFS program, including the right to choose between healthcare providers and care settings." So ACOs are going to transform health care, but individual patients don't need to be part of the transformation if they don't feel like it."
For health reform to work, everyone needs to play their part ... doctors, hospitals, payers AND patients. It only makes sense.
I think that healthcare has so many problems to sort out that it will take two lifetimes to get it right.
Posted by: Neil | Butterfield | 09/19/2011 at 09:21 AM