A Utopian World?

I recently read an article over at the Health Care Blog entitled ACOs and Community Hubs of Wellness and Health. And my mind was blown in a totally awesome way. The article is a few months old, published before the the Paul Ryan (R. Wisconsin) Medicare Proposal, but the premise is intriguing, albeit probably insurmountably difficult to reach.

Kent Bottles, MD, VP and CMO of the Iowa Health System, proposes that ACOs (the Accountable Care Organizations discussed earlier) could be the pathway by which hospitals and associated outpatient centers become Community Hubs of Wellness and Health (CHWHs). Changing from the fee for service status quo to a global payment system of the ACOs will force hospitals to adapt and change. The ones that can make the shift to something more akin to these CHWHs will survive.

It won’t be an easy transition. Hospitals will have to move beyond the typical activities of an acute care center and expand to become beacons of overall preventative medicine through generalized wellness. One example Dr. Bottles gives is the possibility of offering farm fresh meal options, or even a Friday Fresh Farmer’s Market, like they’ve established at Kaiser Permanente Oakland Medical Center. Another suggestion is that these CHWHs utilize social media and smart phone technology to bring in patients through education of those that might not be familiar with such ideas. These centers will be hubs for the community to come and interact and be healthy, hanging out and being together in health. Sounds a little far-fetched, but definitely ideal.

Developing hospitals into trusted centers is not going to be easy though. For a long time many people have seen hospitals as scary places, places of death and dying, illness and fear. Hospitals will have to make the move to CHWHs before they get the trust of the community, slowly over time. Implementing the healthy food options, weight loss plans, smart phone technology sessions, community talks on healthy living, creating ‘hang out’ areas like cafes and wifi zones, and altering mission statements to include more social determinants of health are a few ways to get started on this concept and there are a few hospitals that are already working toward these goals.

With trusting patient bases, the hospital will more effectively meet the objectives of the ACOs. Patients respond better to treatment when they trust their physician and hospital. Non-compliance is much more common from patients who do not trust their organization. With higher rates of compliance, there is an increase in the preventative success of the system, exactly what the ACOs are working towards.

Somehow these ACOs are supposed to provide better care, cheaper care, and faster care. By using the primary care physician and relying less and less on specialty medicine, preventative care will become the focus, saving money by only doing the most necessary procedures and seeing fewer patients in the hospitals and more in outpatient settings. Hospitals and physicians will make money by successfully treating patients and keeping them out of the hospital.

As someone going into medicine, this concerns me a bit. I am naturally supportive of this shift to ACOs. I think the fee for service status quo is damaging to patients and clearly doesn’t work. This new system is the best idea we’ll probably see for a long time and I support it from a social perspective and someone who tries to champion the rights of those who are disempowered. But as a future physician, someone who will be making my living, my money, in this field, I am a little worried. I don’t fully understand how preventing hospitalizations will lead to a steady and sufficient income for medical practitioners. I understand that Medicare will reimburse and give incentives to organizations that keep costs down, chronic patients out of the ER, and unnecessary tests to a minimum, but what is the real translation to a physician’s income?

Are the days of doctors making big money over? I’m not going into medicine for the money, but being well compensated after years of schooling and massive debt is something that is akin to a safety net for new docs. I don’t need to be making 500k a year or anything, but enough to be comfortable or even a little more than just comfortable would be nice. I have and will continue to work very hard for this profession and come from a background where we constantly struggled and I feel just a little entitled to be making a high income. I don’t think this means I’m focused on going into medicine for the wrong reasons, I think it makes me practical. Honestly, though, if I only made 50k as a physician I’d still go into it. I’d have to do one of those loan forgiveness programs, though! I might have to do one anyway.

So what do you future physicians think? How do you reconcile a social conscience with wanting to be able to make money? Is this Utopian ideal even possible?


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