Healthcare reform is in full swing. Legislative reforms promise to push healthcare providers toward the type of collaboration and efficiency that will lead to better patient outcomes, and younger physicians are poised to offer more tech-savvy, modern care. However, these changes may not ultimately produce positive results, despite their potential benefits.
A recent article by Forbes examines five of these changes, explaining how each of them has the potential to improve the healthcare system and ways they can fail.
1. Accountable care organizations. ACOs were built into the Patient Protection and Affordable Care Act in an effort to improve care and reduce costs. They facilitate collaborative environments in which patient information flows between various healthcare providers.
However, ACOs are frequently hard to implement. According to the report, many physicians and hospital administrators are unwilling to relinquish autonomy or authority for the sake of achieving greater collaboration
2. Implementing alternative payment models. Alternatives to the traditional fee-for-service models that pay physicians based on clinical outcomes instead of on the amount of services provided are springing up across the country and are designed to reward physicians for providing high quality care at a lower cost to patients.
Prospective, or bundled, payments, comprised of a single payment for an entire episode of care, have proven a feasible alternative, according to Forbes. Another approach is capitation, or a set price correlated to quality and service required for a group of patients.
These payment systems come with implementation challenges. For patients with conditions treatable by one provider or one group of providers, a bundled payment system would be easy to apply. However, patients with complex problems, like multiple chronic diseases, that require care from different specialists or provider organizations introduce the issue of how these different providers should be paid, according to the report.
3. Rewarding quality of care and patient satisfaction. Under Medicare Advantage, participating healthcare providers must submit reports on quality and patient satisfaction to CMS every year. These reports are then used to award successful organizations with additional payments. According to Forbes, this program has demonstrated improved clinical outcomes, increased patient satisfaction and ensures that physicians are paid for the value and quality of care they provide their patients.
Despite its advantages, these Medicare Advantage beneficiaries are still in the fee-for-service model rather than the desired fee-for-value model, according to the report.
4. Meaningful use of health IT. The goal of using modern health IT in healthcare facilities is to provide physicians with resources for automation, efficiency and care coordination.
However, the many benefits of health IT may never be realized within some healthcare facilities because interoperability issues and cultural resistance act as barriers to successful implementation. According to Forbes, the combination of disparate technology systems and employees' unwillingness to modify workflows impede the adoption of modern health IT.
5. A new generation of physicians. The newest generation of physicians is a fundamental resource for improving U.S. healthcare because new physicians are more tech-savvy and more teamwork-oriented than their predecessors, according to the report.
This generation of physicians possesses traits that can promote positive change in the healthcare system. However, the report highlights the concern that these new physicians might lose their enthusiasm once they understand the demands of being a modern physician may prevent them from achieving the work-life balance they desire, or they might become frustrated with the healthcare system's reluctance to change.