Mother knows best, as the phrase goes, and just like my mother, she always knew how I was feeling and what I needed before anyone else. Running a fever? Mom knew before she even put the thermometer in my mouth. In fact, I specifically remember my mother telling my father, “I think he’s getting sick,” before I ever felt any symptoms. I always wondered how she knew such things. Moms know their children so well that even the slightest change in skin color, temperature, breathing, or personality sets off a red flag that tells them, “We need to go to the doctor!”
Fast forward to adulthood and the responsibility of making sure you are healthy falls squarely on your own shoulders. There’s nobody there to make sure you take your medicine, see your doctor every year, and get enough rest. Without an inherent motivation, how healthy are you? If we look at CMS numbers, as a country, maybe we aren’t doing as well as we would hope, with two-thirds of beneficiaries having multiple chronic conditions. This is why the Center of Medicare and Medicaid created the Accountable Care Organization. The responsibility of your wellness is tied to provider reimbursements and bonuses. The missing “mom piece” is added back into your healthcare. Your primary care physician becomes your greatest asset in ensuring proper health and maintenance.
So how are providers held accountable? The consumer Assessment of Healthcare Providers and Systems (CAHPS) is a patient survey, which identifies just how communicative and involved the provider is with their attributed population. For quality healthcare to be effective, there has to be a solid relationship at the foundation. Someone has to care the way your mom did!
Another way providers are held accountable is through the Group Physician Reporting Option (GPRO), which consists of a number of quality metrics governing topics of preventative medicine, chronic care management, and population health. In order for ACOs to see their first penny, if they’ve saved enough money, they must be in full compliance with GPRO.
Dr. Holzer, CEO at Lacuna Health, spoke at the FLAACOS 2018 Conference (pictured above) about how our health system has focused on episode-based financial incentives as opposed to truly focusing on patient needs, and I believe he is right. Since the beginning of the Medicare Shared Savings Program in 2012, every thought, Final Rule, and amendment to the MSSP program has been with “Patient Care” and “Population Health” as the battle cry. However, fee-for-service and distribution of dollars have been the backbone.
Maybe it’s time to really sit down and think about how patients are cared for instead of how much we can make off of care. A well-respected physician who practices in an ACO once said to me, “If I have the right incentive structure behind me, I know comfortably, that if I give the right care to my patients when they need it, the money will follow.” Those are the words our doctors across the nation need to speak. It’s time for our legislation to provide those incentives.
