Accountable care organizations: The lost art of medicine?

by Sharolyn Rhees Medina, MD

It’s no secret that healthcare’s inevitable move toward accountable care organizations (ACOs) has many physicians feeling a bit …nervous. Admittedly, most physicians are creatures of habit who fiercely defend their individual approach to patient care, focus on cures not cost, and dread the concept of “cookbook medicine.”

And under the ACO model, physicians are going to, without a doubt, be expected to move out of their comfort zones. But while ACOs will put new pressures on physicians to observe and adhere to evidence-based best practices, they will also allow physicians to preserve and deeply embrace the “art of medicine,” as well as enhance physicians’ skills and help improve outcomes by enabling them to spend more quality time with patients.

Our current healthcare system isn’t designed to encourage physicians to take a course of action that’s economically effective – especially since physicians are reimbursed by the service, regardless of the time spent and inefficiency it causes. The application of evidence-based best practices within ACOs will play a critical role in not only improving the economic system of healthcare, but the quality of patient care by making physicians accountable for outcomes and giving them the proven guidelines to help them do so. Physicians who practice good medicine – guided by best practices, but still driven by their own science – will see the reimbursements follow. This will cause a fundamental shift where physicians will be paid by the quality of their work, not the quantity of it.

In actuality, this model will give them the freedom to more deeply embrace the art of medicine and spend more time with patients – so it’s not just about money. It’s about making the physician’s job easier so they can focus on the more complicated and “heavy lifting” part of patient care. Yes, shaving half a day off ICU stays can result in significant savings over time, while reducing the number of blood tests required for a diabetic might not save a ton of money. However, fewer blood tests reduce the time physicians have to spend evaluating repetitive results, which means they can shift their attention to the patient and patient care.

Inpatient settings – which have a high-volume of patient visits and are swimming in a sea of valuable raw data (vital signs, lab results, etc.) – will likely see the biggest changes from the ACO model. In a ACO, all of this data can be converted into actionable intelligence that can quickly expose an abundance of inefficiencies that will ultimately help shift physicians’ mindsets from quantity to quality and enable them to focus on what they do best: the art of medicine.

Sharolyn Rhees Medina is an emergency medicine physician.

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