Wednesday, March 07, 2012
CHUs and ACOs
A Cultural Hang-Up (CHU for
short) happens when a value or an idea or a practice becomes so firmly engraved
in our cultural subconscious that it keeps us from doing something that is both
sensible and beneficial.
ACOs are a case in point.
ACO is short for Accountable Care Organization, a concept that has been
bandied about in the health care literature for some time and found its way
into the Patient Protection and Affordable Care Act, known popularly as
ObamaCare. As its name implies, an ACO
is an organization that can be held accountable for both the cost and quality
of care. It is a response to the
historical fragmentation of the health care delivery system, of which the
hospital and its largely independent, self-governing medical staff is perhaps
the most significant example.
The federal government is jumping through all kinds of hoops
trying to define what will qualify as an ACO, apparently based on the premise
that health care will typically be provided under that traditional pattern. How much simpler it would be if the
authorities would just say that the prototype ACO will be a hospital that
employs its medical staff, thereby unifying the major components of care and
acquiring the ability to be held accountable.
There are already institutions like that. Most University-owned teaching hospitals are
medically staffed by employed physicians, as are hospitals operated by large
group practices like Mayo, Cleveland Clinic, Geisinger and Leahy. Such hospitals are very difficult and
expensive to create, however, and there are not likely to be more of them.
Among the private hospitals that quality, The Henry Ford
Hospital in Detroit
is perhaps the best known. The Myrtue Medical
Center in my home town of Harlan , Iowa
is another. Undoubtedly there are
more.
Replicating these examples would be the easiest thing to
do. Hospitals are already hiring
physicians at a rapid rate and the trend could be accelerated by adopting
measures such as grant programs that covered part of the cost, and tax
incentives that encouraged physicians to accept employed status.
But I have yet to hear anyone suggest anything along those
lines. Most likely that is because the
institution of private practice is so deeply entrenched in our culture that any
suggestion that it be replaced is not socially acceptable, even though it is in
steep decline.
CHUs can impede progress.