Jason Sandford
Jason Sandford is a reporter, writer, blogger and photographer interested in all things Asheville.
Mission Hospitals and Crescent PPO are exploring the creation of a new network aimed at improving the coordination of medical services to Medicare recipients, according to word on the street. The new “accountable care organizations” are encouraged under changes that will take effect Jan. 1, 2012 when President Obama’s health care reform bill takes effect.
Accountable care organizations are provider groups that accept responsibility for the cost and quality of care delivered to a specific population of patients cared for by the groups’ clinicians.
The creation of an accountable care organization is not mandated under the health care reform, but the federal government’s health care program for senior citizens strongly encourages it as part of changes to the way it will pay reimbursements starting in 2012. These Medicare payments are hugely important to hospitals because those payments make up a substantial portion of their revenue.
The encouragement from the federal government comes in the form of cash – qualifying accountable care organizations will get a share of the money saved by lowering costs. Also, Medicare is cutting the amount it pays a hospital that readmits a patient with certain illnesses within 30 days.
The Mayo Clinic operates on the accountable care model, and Mission Hospitals is apparently quite fond of the Mayo Clinic paradigm. Mission Hospitals is Western North Carolina’s behemoth of a health care system – more than 6,000 employees and $1 billion in revenue. Crescent is a regional provider-sponsored preferred provider organization (PPO) covering 16 counties in Western North Carolina.
Not everyone is a fan of the ACO model. Some doctors think they could lose clinical independence by operating in such a network. A recent Huffington Post story spells out the concerns of some doctors. It notes that the American Medical Association recent issued a statement that “asserts that, ‘ACOs must be operationally structured and governed by an appropriate number of physicians to ensure that medical decisions are made by physicians (rather than lay entities) and place patients’ interests first.'” The article continues:
Several days later, similar words of caution were sent from the American Osteopathic Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Physicians.
The principles are a response, in part, to a growing trend among doctors who decide to give up private practice in favor of employment with hospitals. Earlier this year the Medical Group Management Association conducted a survey that showed the percentage of hospital-owned practices grew from 26 percent in 2005 to 55 percent in 2009, more than double in just four years.
The move away from privately owned physician businesses is motivated by frustration over mounting costs and lower reimbursements.
I’m only just now learning about this issue. Does anyone have more information on how this discussion is playing out in Asheville’s health care community? What are the other pieces to the puzzle? What other issues would an “accountable care organization” raise? Suggestions, tips, references, etc. are welcome.
Just one comment for now – reading the above one might think Mission and Crescent are working together. They are not. Crescent is looking at creating a bottom-up model collboratively owned by local physicians/hospitals. Mission would likely create a top-down model which they solely control. These are very different approaches, and it will be interesting to see which model our area physicians choose to back.