Home > Employee Benefits > Doctors, the Affordable Care Act, technology and ACO’s: the mystery recipe

Doctors, the Affordable Care Act, technology and ACO’s: the mystery recipe

Recently, several members of the WGA Employee Benefits practice read  Shannon Brownlee”s book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer as part of a continuing education seminar about the health care delivery system and employers.   Many readers were struck by the fact that while the book was written before the Patient Protection and Affordable Care Act, some of her ideas are part of health care reform. During the seminar, we talked about any aspects of the act that may actually help the delivery system and came up with two: funding for electronic medical records, and support for the creation of organized systems of care. At a minimum, this is a book that most of us should read.

Second, HCPlexus and Thomson Reuters released the results of a large survey of physicians on their perceptions of the impact of the Act. Not surprisingly, most physicians think the Act will have a negative impact on them, mostly because they are worried about their income. The two surprising parts of the survey were:

  1. PCP’s were more supportive to neutral about the Act. Specialists were almost universally negative. Brownlee believes the growth of specialists has been a part of our health care problem in this country. Maybe we need to tip the scales back to a primary care focus, and a few PCP’s were quoted saying just that. This could be a good thing for our clients and their people.
  2. Physicians were almost equally divided on the benefits of electronic medical records as being positive (39%), neutral (37%) or negative (24%), but the quoted physicians with a positive reaction already have one. The negative respondents seem to have no direct experience with electronic medical records. Not an unusual response from people who don’t like change. As an interesting side note, the US dramatically lags behind other wealthy countries in EMR usage, and as Brownlee showed, EMR’s have been a valuable and positive tool for the VA system.

The survey also asked physicians about Accountable Care Organizations, but when it was conducted, very few physicians even knew what an ACO is. Of the 12% that did know, 80% were becoming part of an ACO – a small but positive trend. That leads to the third data point of the week.

One WGA EB member knows the medical/quality director of one of the larger hospital affiliated physician groups in Massachusetts, and one of the first to enter into the Alternative Quality Contract with Blue Cross Blue Shield of MA. After approximately 2 years under this contract, the director said that the group’s experience has been significantly better than it was in the past, and better than any of the non-AQC delivery systems. Their quality was better, their utilization was down and their outcomes had improved significantly. Their costs to the system have gone down! How long have we waited for a large provider to tell us costs are down and quality is up?

While we don’t have all the answers, all of these little events are certainly making the future interesting.

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William Gallagher Associates is a leading provider of insurance brokerage, risk management and employee benefits services to firms with complex risks and dynamic needs, within industries that include technology, life sciences, financial risks, health care, renewable energy & clean technology, and environmental services. WGA has offices in Boston, MA; New York, NY; Hartford, CT; Princeton, NJ; Columbia, MD; and Atlanta, GA.

  1. jeff
    February 13, 2011 at 2:07 am

    Scott, You sure want a qualified specialist when you or your loved one is an a car wreck and broken? When you have a septic abdomen from perforated viscus? When you have cancer? All the primary care and physician extenders in the world, will not even come close to all the hard work/dedication that specialists provide. I, as a specialist, am tired of being demonized, and listed as the problem. People are going to see what they didn’t really realize…just how hard, dedicated, loyal, and intelligent that specialists are…when all specialists are dismissed,discouraged to practice, and the brightest are discouraged from doing what it takes to become a specialist—the rigors/training/dedication/stress, etc… wow…demonizination and now saying specialists are THE CAUSE…you need to take some classes in demographics, and just see how many people are getting old worldwide, how much pathology there is, and finally talk to system analysts who study multi-variable systems, and how all inefficiencies in any systems as complex as medicine cannot be wringed out, and most of all, there is a lot more pathology in people than resources to pay, and the most cost effective(and real demons—are behaviours/risks by the patients themselves)…don’t worry, specialists will be there for you and your family…we are dedicated, do so much work that you, the general population, have no idea of what we do in our practices…glad to hand primary care docs a lot of the stress, liability, and responsiblities, night time work, etc… ps. A lot of primary care providers will need to brush up on the names of bones in the body, much less the pathological conditions that exist…there is a huge knowledge gap for primary care to even be effective screeners/rationers, much less take over treatment plans…better get those computer algorithms going in high speed…

    I guess you can tell my feelings are hurt…please don’t demonize specialists…we are not the problem…and there wont’ be perfect health, and low costs without us…Canada and England, still going broke in their health care…demographics, simple math

    I have EMR, PACS (one of first practices in my town/state) and go to meetings, work very hard, and have taken care of thousands of patients who are better off after treatment(saved lot of lives as well)

    One of my sayings: Generalists(primary care) need to specialize, and Specialists(subspecialists in academic centers/cities) need to generalize…I’m a general orthopaedic surgeon in a rural town, and take care of diabetic feet, order/treat insufficiency fractures in patients with osteoporosis, attend to nutritional needs in malnourished patients with MRSA infections, etc. I, like a lot of my colleagues, provide care to the whole patient, coordinate care with primary care doctors, and counsel patients, athletes, workers on life skills/exercise/nutrition, etc. I’m not a subspecialist in sports in a big city…I am not the exception in our specialty…but specialists like me are lumped in with the ones you think of, and I wish you, the public, Dartmouth could see those of us in the trenches who do it right. thanks for your time/consideration

  2. Scott Kirschner
    February 14, 2011 at 3:00 pm

    Jeff,

    Thank you for your passionate, detailed defense of yourself and your profession. In response, the first thing I would share with you is that my father is a retired general surgeon – truly a “specialist that generalized” in your words. (I like that phrase so much that I actually plan to use it myself, naturally attributing it to you.) He was also the long time director of Arizona’s Medicaid Agency, and we have discussed the good, the bad and the ugly in the health care system virtually weekly for the last 25+ years. I did not arrive at these ideas in ignorance.

    Second, in my own defense, I said that specialists are “a big part of the problem”. Not “the problem”. And that I think we need to tip the scales back towards primary care. I agree that I would not want an internal medicine physician treating me in an ER after a car wreck, but I also don’t think a cardiologist providing a routine screening is an appropriate use of resources in most cases. I agree that primary care physicians need more training; if they could only find the time. I also think there are significant geographic treatment differences happening nationally (health care in Boston may be world’s different than where you are). It sounds like you are doing so many things right. I know there are others like you. I just wish more physicians were on board because I also know the opposite.

    To further elaborate, I think there are a litany of problems, and I agree that another big one – maybe the biggest – is the patient and the pathology of our aging population. Too many Americans eat whatever they want, don’t exercise, are not compliant with physician instructions, look at health care as an entitlement, expect to live forever and want the latest drug, test or treatment they heard about on TV or the Web. People need to look in the mirror more and admit that they are part of the problem.

    Throw in the technology and device arms race. The annual meeting of the AAOS starts tomorrow in San Diego. If you are attending and go to the Technical Exhibit hall, I would hope that you would ask about the cost/benefit of the various vendor’s products. I would hope that you would be the first to say that a simple test or even none is sufficient when the patient says “give me the 3-D MRI” or when the salesman tries to convince you to upgrade. We need more of that from physicians and hospitals.

    I could go on about the problems in the system: behaviors with insurance, end of life care, the role of government, malpractice costs and behaviors, uncoordinated care, unnecessary testing, etc. I applaud your commitment and hope that you recognize the role you and your colleagues play in both the good in the system – the lives improved and saved – and the bad – soaring uncontrolled costs that employers and their employees are having a tough time affording. I have literally had clients fire people to afford health insurance for everyone else (or simply not hired new people). Think some of them the next time you feel “demonized.”

    Thanks for commenting

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