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Accountable Care Organizations and Primary Care

Created February 15, 2012 by Rick Pescatore
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Everyone seems to be talking about Accountable Care Organizations—ACOs. From New York to Los Angeles, the new regulations developed in the Affordable Care Act of 2010 have become a much-debated and thoroughly studied topic. According to the federal government, implementation of Accountable Care Organizations and the PCMH (Patient-Centered Medical Home) will streamline health care, improve quality and efficiency, and make medicine more affordable for Americans.

One way an ACO can be understood is by examining it in the context of an integrated, single-site PCMH. Envision, for a minute, the ubiquitous medical office buildings that are almost certainly just a few minutes down the road. Currently those centers house a variety of physicians and other health care professionals working independently under the classical medical system, with the back of one cardiologist’s office abutting his radiologist neighbor.

A single-site patient-centered medical home would see those walls knocked down, and would unite physicians of all specialties under a single roof—one where a patient could be seen by all of her medical providers, from head (neurologist) to toe (podiatrist). Of course, this isn’t the only possible iteration of the PCMH model. Accountable Care Organizations and Patient-Centered Medicine simply present a unified and user-centric care model, no matter how many roofs it falls under. United under a single electronic health record (EHR) system and with each patient’s care streamlined by an experienced health care provider, proponents argue that Accountable Care Organizations can eliminate redundancies, decrease errors, and save money.

To get a further perspective on the impact of ACOs on health care as it functions today, I caught up with Carol Henwood, DO, FACOFP (dist.). Dr. Henwood, a graduate of Philadelphia College of Osteopathic Medicine, is a board-certified family physician in private practice in Pennsylvania. As a Governor of the ACOFP Board, Dr. Henwood helps establish national health care policy and training standards for her profession. In addition, she currently chairs the Board’s Task force on Medical Homes and Accountable Care Organizations. Here’s what Dr. Henwood had to say about medical homes:

I believe the PCMH model to be the basis of health care delivery in the US and the world. Every day we see more adoption across the US—the VA and the military have adopted the model—and thousands of practices across the country have become NCQA-recognized practices. Currently, several other organizations (URAC and JCAHO to name a few) have begun recognizing practices.

But—what does this mean for a future physician? According to Dr. Henwood, beyond the ability to provide increased quality of care, Accountable Care Organizations allow for enhanced reimbursement for quality care delivered, as well as the opportunity for primary care practitioners to take the lead in development of reimbursement models in the shared savings arena. Clearly, Dr. Henwood is an advocate for the resurgence of the medical home, and as medical students and pre-medical students, we can all likely expect to encounter this system in some iteration in the future.

Having covered the ins-and-outs of ACOs, I took the opportunity to delve further into Dr. Henwood’s experiences as a family physician. In particular, I asked her about her role as a primary care practitioner—often considered the “first line” of medicine, where illness and injury can be identified early-on and addressed. Here’s what she had to say:

No one knows a patient better than the primary care physician. At one visit a patient came to my office with a chief complaint of “intermittent tingling” in her left thumb without motor deficits or any other symptoms. I knew her NEVER to present to the office for frivolous complaints, and her subsequent MRI (after arguing with the insurance company to get it approved) showed a glioblastoma. I doubt the study would have been ordered immediately by someone who did not know the patient as well.

Certainly a potent example of the power of primary care! Furthermore, Dr. Henwood brought up an important topic—one we hear of often as medical students, yet can never fully grasp until we hit the clinics on our third and fourth year rotations. With health insurance companies and organizations like Medicare and Medicaid footing the bill for procedures, office visits, etc., there is a rarely seen dynamic between the primary care physician and the insurance company.

It is necessary to play by the rules (formulary restrictions/prior authorizations for tests, etc.), but it is my job to practice quality care and to be the patient advocate to get them the care they need.

It’s a lot to think about—with the American health care system at a precipice, students like you and I will almost certainly encounter a health care horizon much different than our predecessors. As clinician-advocates like Dr. Henwood lead the way, though, it’s incumbent upon us to do all that we can to prepare ourselves to care for the next generation of patients. As we wrapped up, I asked Dr. Henwood what she would say to her first-year medical student self—the advice she would pass along to a future physician:

Work hard and learn everything you can. You will know what specialty to choose by what you can see yourself looking forward to getting out of bed every day to do. The most important qualities in a primary care physician are being a worrier about the patients who have entrusted their lives to you, and being a listener.

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