Patients at the Center of the Plate

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By Nancy Muller, PhD

Executive Director of the National Association For Continence

By default, 2013 heralds a new year for all of us. Some may elect to take a bold new step into more integrated healthcare than our traditionally fragmented system has historically facilitated or even allowed. Under the Affordable Care Act recently upheld by the Supreme Court in 2012 so its programs could move forward, providers  of various types – physicians, hospitals, and other specially trained health professionals – can organize themselves in groups to coordinate care in concert with a technology company or payer who manages enrollee data. In this way, communication with the exchange of information is improved, rendering a team that collectively is more accountable for quality outcomes than any individual provider or entity, hence the name ‘Accountable Care Organization (ACO). While most ACOs that have been formed so far have at their hub a community hospital, some have formed under the leadership of primary care physicians, such as Palmetto Primary Care in South Carolina1 .

ACOs were first constructed to serve Medicare beneficiaries not already in a healthcare maintenance organization (HMO) such as offered by Humana because older people typically require the most care. Consequently, health care dollars are highest in expenditures on the elderly, therefore representing the greatest opportunity for savings. The Center for Medicare & Medicaid Services (CMS) offers financial incentives to the ACO to be more cost efficient in its delivery of services by allowing the ACO to receive half of the dollar savings it generates for the Medicare enrollees under its care. The incentive – and the concept of such arrangements – was conceived under the Affordable Care Act. Today, there are approximately 90 ACOs nationally which participate in this shared Medicare savings arrangement.

The National Association For Continence (NAFC) remains hopeful that Medicare recipients – whether enrolled in a Medicare HMO or receiving care under the new ACO structure – will witness an earlier, comprehensive, and accurate diagnosis of a pelvic floor disorder or voiding dysfunction than they might have previously under traditional coverage. With a multi-functional, multi-specialty team, it is conceivable that the benefits of combination therapy – such as behavioral therapy in combination with a prescription drug, for example – can become the norm rather than the exception. In this example, a physical therapist or nurse specialist might provide pelvic floor muscle exercise instruction with biofeedback at the same time that a doctor or physician extender prescribes a drug for overactive bladder. The technology company would keep track of prescription refills for a record of compliance. Repeatedly, research demonstrates superior results and effectiveness of combination strategies of various kinds. Even patients undergoing surgery need behavioral therapy to achieve and maintain continence. Often, it is a team that a patient needs for marked improvement or cure. Find that team and be its center.

1Ratcliffe, Lauren, ACOs track health outcomes for Medicare. Charleston Business Journal, October 7, 2012, p. 7.

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One Response to Patients at the Center of the Plate

  1. Cinta says:

    Professor Dranove makes many excellent pontis in this blog. It is worth noting that in the early 1970 s Certificate of Need regulations and laws were recognized as a means of blocking new entrants to the market. (By the late 70 s, protected institutions were using the term interlopers to refer to potential new entrants.) Gregory Raabs doctoral dissertation at the University of Virginia (mid 1970s) addressed the question of the role of CON in protecting the status quo.A half century later, the answer is still clear: It was effective. The extant health system has an uncanny knack for co-opting disruptive technologies and blocking their potentially positive effects.Although Professor Dranove criticizes big box retail operations, they have the capital, and perhaps the business acumen, to successfully carry through some new attempts at disruptive technology in the point of care arena.James E. Lewis, PhD

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