Interim Meeting 2013

Interim Meeting Ethics Forum: Ethics in ACOs

Posted in Accountable Care Organizations, Ethics Forum, Global Payments, Health Policy, Health Reform, Interim Meeting 2013, Payment Reform on December 6th, 2013 by MMS Communications – 2 Comments
Susan Dorr Goold, MD

Susan Dorr Goold, MD

The accountable care organization (ACO), loosely defined as a group of providers that accepts responsibility for the total care of a patient and is accountable for high quality care and the cost of care, is a rapidly growing concept whose aim is to reduce the rising costs of care and improve quality.

While the emphasis on ACOs has focused on cost and outcomes, less attention has been paid to the ethical considerations of delivering care within such a structure.  As the ACO continues to evolve, what are the ethical issues that physicians might face as they practice medicine?  Do healthcare institutions, as well as individual providers, face ethical issues as organizations? And how might ethical considerations influence payment structures?

These are some of the issues discussed at the Ethics Forum, held on the first day of the 2013 MMS Interim Meeting of the House of Delegates.

Presenting were Susan Dorr Goold, MD, professor at the University of Michigan and Chair of the American Medical Association’s Council on Ethical and Judicial Affairs, and Philip F. Gaziano, MD, chairman and CEO of Accountable Care Associates, a Springfield-Mass. based healthcare management company.

In two presentations over two hours, delegates heard perspectives on the practical and ethical challenges in making a transition to an ACO, who providers are accountable to and for what within an ACO while maintaining their first loyalty to the patient, conflicts of interest that may arise, and ways to protect patient autonomy while practicing in an ACO.

Some highlights from the presenters:

Dr. Goold, in a presentation entitled Strengthening Patient-Physician Trust in Accountable Care Organization, examined the elements of personal and organizational accountability that lead to strong physician-patient relationships.  Professionals, organizations and patients all have a responsibility in strengthening trust, she said: professionals with a duty to “seek trust from patients” based on openness and honesty, patients by being truthful and to trust wisely, and organizations as “moral characters” in modern society.

Dr. Gould also outlined the challenges to trust in physicians (patient expectations, requests, and demands) and health care institutions such as hospitals and payers (safety of personal information, treatment decisions, fair and prudent use of resources). She concluded with the notion that physicians and healthcare institutions have “moral responsibilities in health care” to include advocacy, competence, fairness, and honesty, among others.

Dr. Gaziano’s Ethical Considerations in Accountable Care Organizations focused on the payment considerations with ACOs, comparing fee-for-service to global payments (payments based on Relative Value Units) to Quality Value Units, a new designation created by his firm that provides the advantages of tracking and reporting in real time, predictive value, and the tracking of quality and budgets. He also addressed physician concerns: why ACOs are different from earlier cost-saving attempts like HMOs and opportunities within the new system of ACOs such as payments and managing budgets.

The presentations of both physicians are available on the MMS website here.


2013 MMS Oration: Engage Patients to Transform Health Care

Posted in Health Reform, Interim Meeting 2013, MMS Oration on December 6th, 2013 by Erica Noonan – Comments Off on 2013 MMS Oration: Engage Patients to Transform Health Care

Moving from a provider-centric delivery system to one that engages and activates patients is key to transforming health care in the United States, said David L. Longworth, M.D.

The transition to a new paradigm of care requires many changes in practice — from working in more collaborative physician-led teams to better use of predictive analytic data by physicians to guide care decisions, said Dr. Longworth, Associate Chief of Staff for Clinical Integration Development at the Cleveland Clinic.

But the most crucial  step left for physicians is to better motive patients to stay as healthy as possible, he said.

“We have a unique opportunity as a physicians to fix what has been broken for so many years,” he said. “Patients are (now) partners with us. No longer are we delivering care to passive individuals.”

Dr. Longworth delivered the Massachusetts Medical Society’s Annual Oration, “The Imperative of Patient Engagement in the Era of Healthcare Reform and Practice Transformation”  at the organization’s 2013 Interim Meeting on Dec. 6.

The Oration is a Society tradition dating back more than 200 years, and features a physician-leader speaking on an issue pertinent to current medical practice.

Dr. Longworth said that engaged and activated patients are more likely to accrue fewer health care costs, experience fewer hospitalizations, emergency room visits and hospital readmission.

These better outcomes are quality measures that physicians can’t ignore under new value-based compensation systems, he said.

Not only must physicians engage their patients  more effectively, they must also improve their interpersonal and coaching skills.  Patients who rated their physicians as more empathetic, had better health outcomes in managing chronic disease, Dr. Longworth said.

— Erica Noonan

2013 MMS Interim Meeting Opens With Call to Protect Smaller Practices

Posted in Health Reform, Interim Meeting 2013, Payment Reform on December 6th, 2013 by Erica Noonan – 1 Comment

Massachusetts Medical Society President Ronald Dunlap, M.D. opened the 2013 Interim Meeting with a call for the organization to support small and mid-sized physician practices during an unprecedented push towards clinical and financial alignment statewide.

“I believe that if a physician or a practice wants to maintain a meaningful degree of professional autonomy, they should be able to do so. Becoming employed by a large system is not for everyone,”  said Dr. Dunlap in his President’s Report to the MMS House of Delegates. “In fact, it is not even necessary.”

Oversight may be needed to ensure that hospitals continue to maintain relationships with affiliated, as well as  employed physicians, and do not attempt to use their market power to dictate terms to independent physician groups, Dr. Dunlap said.

The MMS  plans to continue its outreach on clinical integration challenges facing physicians this into the coming year, Dr. Dunlap said.  The Society’s Physicans Guide to ACOs, created earlier this year, has become one of the most popular documents ever posted on the MMS website.

“We will work hard on the advocacy front to ensure that the rules of the game give everyone the opportunity to be successful — to ensure that we’re not all stuffed into a single model that cannot possible work for everyone,” said Dr. Dunlap.

More than 150 physician HOD representatives traveled from around the state to Waltham on Dec. 6 for the two-day Interim Meeting. They will vote on a number of  formal resolutions, and craft MMS policy for the coming year.

The Delegates also welcomed Aron Boros, Executive Director of the Center for Health Information and Analysis, a state agency created to collect and distribute meaningful health care cost data under Chapter 224, the payment  reform law of 2012.

“The chief health care complaint in Massachusetts truly is affordability,” Boros said.  The cost of health care in Massachusetts is  well above the national average because of  a complex delivery system that withholds information about price and cost from patients and physicians, he said.

The lack of accurate and meaningful data on outcomes and provider quality means the health care system is too often treated like an “all-you-can-eat buffet.”

Beginning in 2015, Boros said, CHIA and the state’s Health Policy Commission will become directly involved with health plans and providers whose health care costs grow faster than the state’s economic growth rate of 3.6 percent annually.

– Erica Noonan