State of the State: 2011

ACOs Offer Physicians New Leadership Roles and Challenges

Posted in Accountable Care Organizations, State of the State: 2011 on November 7th, 2011 by Erica Noonan – Comments Off on ACOs Offer Physicians New Leadership Roles and Challenges

The new world of Accountable Care Organizations will focus on performance measurement, new payment models, and patient-doctor cooperation, according to Dartmouth Medical School professor Elliott S. Fisher, MD, MPH.

Dr. Fisher said ACOs are expected to dramatically shift old paradigms of health care.

“It’s not just a contract, but a journey. It’s not us versus them. It’s a partnership,” he told more than 200 physicians, legislators and industry leaders attending last week’s State of the State’s Health Care Forum, hosted by the Massachusetts Medical Society.

Unlike managed care systems that locked patients into rigid contracts, ACOs are expected to be  more flexible groups of care offering significant patient-doctor collaboration.

Ideally, they will embrace the idea that “the best fence is a good pasture,” said Dr. Fisher, in his talk, titled “How Will Accountable Care Organizations Change Cost and Quality?”

The forum, now in its 12th year, was titled “Health Care Reform: Quality, Cost, and Access – A New Paradigm.”

The challenges for physicians are formidable, as are the rewards, Dr. Fisher said.

The scope of social and technical change is enormous. New  systems will measure many aspects of physician performance and patient health in detailed ways.

Those measurements can’t be overly focused on cost,  he said.

“Consumers fear stinting (on care) and the model will be rejected if there are not measurements that are meaningful to consumers,” Dr. Fisher said.

Practices and hospitals will encounter significant technology infrastructure and organizational and training costs during the ACO transition.  The early phase of the process will be a time of failed experiments as doctors learn “what works and how to improve it,” he said.

However, physicians will have many new opportunities as they guide society through this approach to health care.

“Stewardship will become a core value,” said Dr. Fisher.  “Physicians will be partners in leadership.”

–  Erica Noonan

Health Affairs Editor Warns of Lean Times Ahead for Physicians

Posted in Health Reform, State of the State: 2011 on November 2nd, 2011 by Erica Noonan – Comments Off on Health Affairs Editor Warns of Lean Times Ahead for Physicians

Lowering health care costs has been an objective for decades, but Health Affairs Editor-in-Chief Susan Dentzer argued on Monday that there is “new urgency” among federal lawmakers to tackle the issue.

Income gains in American households over the past 10 years have been largely wiped out by skyrocketing health care costs, and federal health care spending is on track to swell to 25% of the GDP in 2025 if nothing is done.

Physicians and hospitals nationwide will face dramatic challenges in the coming decade, Dentzer told physicians attending this week’s State of the State’s Health Care Forum, hosted by the Massachusetts Medical Society.

The forum, now in its 12th year, was titled “Health Care Reform: Quality, Cost, and Access – A New Paradigm.”

Dentzer predicted that doctors and hospitals will soon need to reduce system-wide costs by 25 to 30 percent, and will be expected to manage most patient care within the financial limits of Medicare and Medicaid reimbursement rates.
The longstanding perception that those rates are too low to provide good care will need to change, she said. “It’s huge shift in thinking,” Dentzer acknowledged.

Additionally, physicians will have to get beyond “the claims and volume” mentality, she said. There will soon be a shift to systems that evaluate overall patent care, measure performance and effectiveness, and require more collaboration, community outreach, and patient participation.

All of the pressure comes at a challenging time, she said. More patients are coming into the system as a result of insurance mandates, and overall social and economic determinants of health are declining for many Americans.

At the same time, Dentzer said, public funding for prevention programs is scarce. “This is a new world,” she said.

– Erica Noonan

Coakley: Physician Perspectives Needed in Health Care Reform

Posted in Accountable Care Organizations, Health Reform, State of the State: 2011 on November 1st, 2011 by Erica Noonan – Comments Off on Coakley: Physician Perspectives Needed in Health Care Reform

Massachusetts Attorney General Martha Coakley on Monday called on the state’s physicians to become more involved in shaping major health care reform initiatives on the horizon.

Physician leadership and input is crucial to efforts to successfully implement new practice models, she said, such as accountable care organizations.

“You can make a difference when you come forward with information,” Coakley told physicians attending the State of the State’s Health Care Forum, hosted by the Massachusetts Medical Society.

The forum, now in its 12th year, was titled “Health Care Reform: Quality, Cost, and Access – A New Paradigm.”

Coakley said many physicians fear that new rules discouraging comprehensive medical testing or hospital stays will open them up to potential lawsuits or accusations of poor patient care.

“I hear from doctors, ‘How do we get medicine and judgment back to where it needs to be?’ ” Coakley said.

Collaboration between physicians, patients and legislators are a key to crafting solutions that will work for the complex and fast-changing health care landscape.

The 2008 payment reform legislation made it possible to start examining ways to bring down health care costs, but the process has just begun, said Coakley.

“There are many ways to fail and only a couple of ways it can succeed,” she said.

There is no quick fix to what Coakley termed a “dysfunctional marketplace.”

“We in Massachusetts have made the commitment to this and have the will and resources to make it work,” said the attorney general.  “When we break down silos we can get real results.”

–      Erica Noonan