Over the Memorial Day weekend, a physician I know, who’s in his late 50s, confided that he’s thinking about retiring. He’s always loved practicing medicine, but he worries that new reimbursement models will reduce his income and force him to turn away some of his longtime patients.
“Medicare will be looking at how well my patients do after I care for them, not just the treatment they receive while in my care,” he said. “Even if I advise them to clean up their act — quit smoking or get more exercise or eat right or take their meds — I can’t force them to. And if they don’t follow my advice, I’ll get dinged. So what am I supposed to do, kick them out of my practice?”
While that view of the emerging pay-for-value concept is simplistic, it does reflect the skepticism many physicians — and others in the health care field, including some hospital executives — have about the shift from our longtime fee-for-service system. By now, some docs and hospital leaders understand that they’ll need to take more active roles in the continuum of care. They understand that their incomes will be affected by their use of evidence-based medicine, the quality of the care administered and the results of the care delivered by all providers involved. And, yes, success will depend to a large degree on how well patients follow their providers’ instructions once the office visit or hospital stay is over.
To help, proactive providers are explaining follow-up steps to patients more carefully, and using teachback methods to ensure they understand what they’ve been told. They’re employing new technologies to monitor patients remotely. They’re sending staff into the community and into homes to promote compliance and wellness. And they’re exploring new models of care that will strengthen relationships with other providers and patients to avoid lapses anywhere along the care continuum.
The most prominent new care model is the accountable care organization, something we explore closely in Hospitals & Health Networks’ May cover story. The article, by Howard Larkin, looks at a variety of hospitals and health systems that have already taken the ACO plunge, sorts out the various types of ACOs that are being tested, and posits important questions providers should consider before deciding if an ACO is right for them. It also outlines several ways that CMS might consider revising the program to encourage more provider participation.