Medicare Won’t Go Broke-Bending the Cost Curve

When the Dartmouth Atlas on Healthcare reported the huge disparity in Medicare spending across the country which could not be explained by differences in the quality of care or different patient populations, Medicare wanted to explore its options on provider reimbursement. Currently, providers are paid by the services they perform without regard to quality and it is estimated that this payment system is a cause of our astronomic healthcare costs. The new healthcare reform legislation will test new models of payment reimbursement all of which use financial incentives to drive down costs and elevate quality.

One program that is going to be tested in the new healthcare reform legislation is the Accountable Care Organization. This is the one-stop shopping model for providing healthcare. ACOs are pretty much modeled after the Mayo and Cleveland Clinic healthcare systems. The ACOs provide continuity of care, from disease prevention and management to speciality care, all under one roof. A good example of this, is the healthcare I receive. I used to receive my care going from one specialist to another without anyone directing traffic, so to speak. There were no electronic records and the doctors were relying on me to tell them my entire medical history. The number of duplicate tests and procedures I received were beyond comprehension. After moving to Dallas, I decided to go to UT Southwestern Medical School in Dallas for all of my healthcare. I have a primary care doctor who looks out for my overall care-whether I’m successfully managing my high cholesterol (which I am) and keeping my weight down (which I am not). Continuity of care issue can be best explained with an experience I had which needed the attention of a specialist.  A few years back I had difficulty urinating, which is symptomatic of an enlarged prostate or prostate cancer. My primary care doctor referred me to a urologist, also at UT Southwestern, and he did further tests and made other recommendations. All procedures and recommendations were recorded on my electronic medical record, keeping my primary care doctor in the loop. To help convince doctors this is the right way to practice medicine, Medicare will incentivize the creation of ACOs by giving cash bonuses. Hopefully, organizations such as this will provide real value to healthcare.


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