At least 838 accountable care organizations (ACOs) are now operating nationwide in all 50 states and the District of Columbia. An estimated 28.3 million people are receiving care through an ACO arrangement, according to recent figures, and that number is expected to rise. Continue reading
We’ve told you over and over again on this blog that the Affordable Care Act isn’t just about coverage. It’s also about changing how health care is delivered, moving away from fee-for-service to a more value- and quality-based system. Medicare is aiming to have half of its payments under alternative payment models by 2018.
That means hospitals have to change. But not all of them want to.
Fee-for-service is the preferred business model for many. Why should those hospitals want to go through considerable expense and upheaval to switch to a new system that demands more – and may well pay less? Continue reading
While we ponder what the court will do about the Affordable Care Act, let’s take another look at one aspect of the law already in effect, the accountable care organizations. We’ve spotlighted good coverage of this in the past, but it’s a concept that still has people confused. Plus, if the court strikes part of the law but leaves sections standing, most of the delivery system reforms – including ACOs – are likely to continue, meaning you may want to cover ACOs in your area.
Tony Leys of the Des Moines Register recently took a look, in a story that did a nice job of mixing local examples and national context, and of blending narrative “real people” stories with a larger explanation. He got lots of space to do so – a mainbar focusing on doctors and patients and a small sidebar, explaining the policy in plain English. Even if you don’t get the space he got, the sidebar works really well as a place to translate the wonky “what is an ACO” that helps the reader but doesn’t slow down the story as much. Good approach for complicated stories.
The story came out in May and, unfortunately, we can’t link to the whole thing. (If we find a way to do so, we’ll update this.) Update: The Des Moines Register has restored the story so our readers can see it. We’ll describe the structure of the story and provide some key quotes that give the reader a sense of what an ACO is.
“Supporters of a new method of paying for health care hope to hear more stories like Dave Kalous’.
Kalous, 57, was diagnosed this spring with a potentially deadly heart ailment. Since then, his doctor and other medical professionals have spent hours explaining the disorder and discussing ways he can try to live with it. Whenever he has a question, someone from the hospital gets right back to him with an answer. Every week or two, a nurse comes to his home to take his blood pressure, ask about his pain and check for complications.
He believes that without such support, he would be struggling more. “I definitely would have returned to the hospital more often,” he said.”
Trinity Regional Medical Center last January founded an ACO, in which hospitals doctors and other providers are judged on “how well their patients fare” not just how many tests and procedures they order. This program is under Medicare but private insurers and large hospitals are forming similar organizations. (Check with the big health plans in your area, like UnitedHealthCare, the Blues, Wellpoint, etc., to see what they’re doing).
Leys also describes how and why some doctors are warming up to the concept.
“Kalous’ physician, Dr. Timothy Ihrig, said he’s glad to see the country move toward a system that rewards doctors for talking at length” with patients about the pros and cons of complicated and expensive treatments.
“We’re in a system now that perpetuates things because they can be done. But should they be done? That’s what we should be asking,” said Ihrig, a palliative care specialist.”
Leys also explains why ACOs are not equal to HMOs … and that quality measurement, the literal concept of “accountable” care is a big difference. Patients also have more choices. And he outlines which patients an ACO focuses on first.
“The Fort Dodge program is focusing first on patients who have chronic health problems, such as diabetes, cancer or heart failure, that are likely to cause multiple hospitalizations. Such people tend to be by far the most costly patients, so they represent the best opportunity to save money.”
He also talks to some national experts (you could get the same result from more local experts at your state universities’ health and public policy programs) about the pros and cons. One of the big worries – as we’ve said before but it bears repeating – is that ACOs may encourage greater consolidation, either more hospital mergers, or more hospital clout over physician groups. It’s worth mentioning in an ACO story and your state hospital association is probably a good place to start.
Editor’s note: Bruce Japsen writes today about the emergence of ACOs for Forbes.com in “Life After The Supreme Court: Accountable Care Catches Wave.”
Resources for explaining Supreme Court’s ACA decision
Webcast: To assist reporters who will need to localize the decision and what it means for their states and communities, AHCJ will host a one-hour online roundtable on Friday, June 29, noon ET, to offer suggestions on stories you can pursue right away and in the weeks ahead.
In these posts about covering health reform, I usually don’t point to the big national dailies because a lot of people have already read those stories but a recent New York Times piece, “As Physicians’ Job Change, So Do Their Politics” is a story that may be able to help reporters think about a good local or regional jumping off point for telling aspects of the health reform story in a more narrative, accessible manner, through the eyes and experiences of doctors.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to firstname.lastname@example.org.
The Times story, by Gardiner Harris, described a shift leftward (or at least less rightward) among physicians. He cited several reasons: younger doctors, more female doctors, and above all more doctors who are salaried employees of hospitals instead of basically being small businessmen (or women) running a practice.
Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.
Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.
He wrote mostly about Maine, but had a few observations about other states, including Texas. Last year Texas physicians opposed the national health reform law by a three to one margin. But doctors who did not have their own practices were twice as likely to support the law. The same goes for female doctors.
How does a story about physician politics translate into a narrative about health reform?
The shift to salaried positions has many causes (including work-balance for doctors who want more time with their families) but the move toward more clinical integration and the formation of accountable care organizations or ACO-like entities will hasten this trend. It is really, really, really hard to explain ACOS clearly and concisely (when an editor of mine recently asked me to give him a nice, tight two-graf description, I began it something like, “One of the challenges of ACO is that they defy simple explanation.”)
But doctors who are joining hospital staffs or whose practices are being bought up by hospitals or who are entering different contractual relationships and affiliations with hospitals have stories to tell. You can also talk about quality measures and “never events” and how that affects physicians and the practice of medicine, particularly in states mandating more public reporting. Through their stories, you can illustrate what an ACO is or isn’t, or how a medical home works, or what “clinical integration” means.
I interviewed a physician in South Carolina the other day, Dr. Angelo Sinopoli, who told me about how the team approach and the use of electronic medical record with clinical decision support was giving him more real-time feedback on his own performance – and he welcomed it.
“You think you are doing something and you might not be, or think you might not be, but you are,” he said. “Seeing real data in as real time as possible made a difference in how we think.” That made me understand an aspect of the electronic medical record that I hadn’t understood before, and readers can grasp that too.
You can explore the changing attitudes and politics along with that – in some states that may be more significant than others, depending on what your state is doing with health exchanges, malpractice legislation, quality reporting etc.
Learn more about how electronic health records could mean new opportunities to improve clinical care and public health, according to David Blumenthal, M.D., the former national coordinator for health information technology. Blumenthal spoke at Health Journalism 2011 as he was leaving his federal position.