Let’s Go To The Numbers
I want you to read something. Here is the article in its entirety from beckershospitalreview.com:
An accountable care organization launched in 2012 by Blue Shield of California, Modesto, Calif.-based Doctors Medical Center and AllCare Independent Physician Association, improved on four quality benchmarks in its first year, according to a California Healthline report.
In its first year, the ACO saw improvement in the following areas:
• Hospital admissions: down 28.8 percent
• Number of hospital days: down 29.3 percent
• Average hospital length of stay: down 0.6 percent
• Emergency department visits: down 9.3 percentTo achieve these quality improvements, the ACO provides better coordinated care for patients through various means, such as scheduling follow-up appointments during discharge and having a nurse call to check in on the patient while they are at home, according to the report.
The ACO covered about 8,000 Blue Cross HMO patients in Stanislaus County in its first year.
Somehow I found this piece because the media picked up on the “great” outcomes and it spread virally. Let’s look at the numbers, shall we? They had a base 8,000 patients. That’s basically the panel for three doctors, which is way too low to make any claims of significance or how great an ACO is! Now look at how they define quality – reducing hospital admissions, hospital days, length stay (same thing?) and ER visits. Forget the fact that these numbers can be gamed. Forget the fact that with only 8,000 patients a small change makes any difference look huge. The issue for me is that all they are talking about is simple system improvements. I am all for that. Getting patients in to see the doctor instead of pushing them to the ER is great. Having a nurse call to check on the patients is great. It says nothing about the quality of the care. The doctors there could suck for all we know. Throwing that term “quality” around means nothing.
I am sorry but this report is just another fluff piece to promote ACOs. I understand the intentions behind it were good but the report fails to mention how much money was lost or saved by this project? Interesting how that was missing. Do you have the money and time and staff to constantly track and “account” those patients who are frequent flyers of the system? And what do you do about Mr. Jones, the long time alcoholic with chronic pancreatitis who won’t stop drinking. Are you going to fire him because he makes your numbers (ER visits, hospital admission, hospital stay, etc.) look bad? Heck, in a three person group with 8000 patients, Mr. Jones can skew the numbers himself. In fact, he can make your whole ACO go from a “quality” team who gets gold stars, diamond status or any other bullshit award you can make up to one that is now labeled poor “quality”, where the insurance subsequently directs patients AWAY from your team or pays you less money per visit due to your new status. Yeah, I think you may fire Mr. Jones then, huh?
I am one of a 3 doc’s group , and we average in total , 2 to 3 patients / day in the hospital . They are taken care of by the hospitalists and we have very little control over who is admitted and when they are discharged . We try to see all patients in our offices or walk in center when possible , except for chest pains , SOB or active stroke / bleeding etc … The length of stay does not reflect the quality in our office as we have no control over that .
Of course there are frequent flyers , with multisystem problems , panic disorders etc . They require a lot of resources from hospitals and office staff / physicians , but it would be quite an awful medical system if the docs were to ” Drop ” the sickest patients to better their ” numbers ” . . .
The intentions behind ACO’s may have been good, but was it a good idea? And if it was, then why are private citizens mandated to participate? It always comes back to the use of force, which will always alter behavior toward least resistance.