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.

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