We’re a long way from us­ing care man­age­ment to re­duce costs, a reader says

Modern Healthcare - - Editorial -

The whole idea be­hind bun­dled pay­ments is to trans­fer clin­i­cal and fi­nan­cial risk to providers (“Ty­ing it to­gether,” May 3, p. 31). Depend­ing on the iden­tity of the “at-risk” provider group and their in­terim ba­sis of pay­ment, how­ever, in­cen­tives may still not be aligned to cause in­di­vid­ual prac­ti­tion­ers or in­sti­tu­tions to fully con­sider the im­pact of their care man­age­ment de­ci­sions on the over­all cost of an episode of care.

Global and bud­geted cap­i­ta­tion agree­ments were also meant to in­cent in­di­vid­ual physi­cians and hos­pi­tals to con­sider the fi­nan­cial ram­i­fi­ca­tions of their clin­i­cal de­ci­sion­mak­ing. For those treat­ing more of the “gar­den va­ri­ety” type of pa­tient, the in­cen­tives gen­er­ally worked in fa­vor of at-risk groups; for groups treat­ing pa­tients hav­ing a higher ill­ness bur­den, the re­sults were of­ten dev­as­tat­ing.

I am as­sum­ing that the pro­po­nents of ac­count­able care or­ga­ni­za­tions and med­i­cal homes have fac­tored the cost of high-acu­ity pa­tients and cat­a­strophic care into their fi­nan­cial cal­cu­lus when es­tab­lish­ing these types of care con­structs. The re­al­ity is that while the po­ten­tial ex­ists to re­duce the long-term med­i­cal cost trend through more ju­di­cious care man­age­ment, we are a long way from that ideal fu­ture.

Jonathan B. Po­ma­zon In­de­pen­dent health­care devel­op­ment ex­ec­u­tive Bev­erly, Mass.

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