Monday, December 10, 2012
On Accountability
The Accountable Care Act (a.k.a. Obamacare) makes provision
for something called Accountable Care Organizations (ACOs for short). These organizations are to include enough of
the major components of care, both professional and institutional, to allow
them to be held accountable for outcomes, safety, and cost, something that has
been difficult to do in our traditional provider system.
The idea of accountability is a good one, but we have yet to
figure out how these organizations will be held accountable and by whom.
A lead editorial in the November 2012 issue of the AARP
Bulletin was titled “Let’s Launch a War on Waste.” It began by pointing out that the importance
of hand washing by the providers of health care was first identified some 165
years ago and has been repeatedly confirmed since that time, but, according to
a recent study by the highly regarded Institute of Medicine (IOM), something
like half of all health professionals still do not follow proper hand washing
technique.
The IOM was further quoted regarding the avalanche of
scientific and technological advances, which have stressed “the capabilities of
the system to effectively generate and manage knowledge and apply it to regular
care” resulting in the waste of some $766 billion per year.
The editorial concluded by challenging patients to
participate actively in their care and to be more observant about what
providers do, even to the extent of reminding them to wash their hands. The implication here is that it is patients who
are responsible for holding providers accountable.
I’m not sure that is enough.
I’m skeptical that providers will be much influenced by patients acting
one at a time.
I had hoped at one time that large employers would take on
the role in evaluating provider performance, but they have shown no inclination
to do so.
Government can try, but the need to follow legal processes
severely hobbles its effectiveness.
That leaves insurance companies. The difficulty there is one of persuading
subscribers that decisions are being made in their interest rather than in the
interest of the insurance company’s stockholders. Non-profit Blue Cross plans don’t have that
problem, at least to the same extent.
So the question remains.
How are ACO’s to be held accountable and who is to do it?
