August 23rd, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, News, Opinion, Research
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Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act (PPACA). The concept behind ACOs is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia) we can expect to see an improvement in quality and value.
In principal, accountable care makes a lot of sense. Practicality speaking, however, doctors and hospitals must address a huge challenge before they can expect benefit financially. Before doctors can be held accountable for the care they deliver, they must first be held accountable for the quality of their communication with patients.
Take hospital readmissions, which are a big healthcare cost driver today. According to a recent study in the New England Journal of Medicine, 20 percent of all Medicare patients discharged from hospitals were readmitted within 30 days, and 34 percent percent within 90 days. The Joint Commission and others rightly believe that inadequate communication between physicians — as well as between physicians and patients — is a major contributing factor. Read more »
*This blog post was originally published at Mind The Gap*
August 11th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion
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In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks — that is, the re-admission of recently-discharged hospitalized patients. They bring up good some good points, and point out that until recently hospitals really didn’t have any incentive to reduce bouncebacks:
…hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum for each inpatient stay — shorter stays equal higher profits. When patients bounce back, hospitals can charge the insurance company twice for the same patient with the same problem. Many hospitals also view bouncebacks as out of their control: If a patient boomerangs back because she doesn’t follow doctor’s orders, it’s not the hospital’s fault.
With health reform, however, things are changing. In an effort to reduce bouncebacks, hospitals are paid less for re-admissions, and they must publish their bounceback rates. Read more »
*This blog post was originally published at KevinMD.com*
June 22nd, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, News, Opinion, Research
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The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication.
There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. Read more »
*This blog post was originally published at Mind The Gap*
