AcuteCare Telemedicine Blog

The Times, They Are A-Changin’

Health care reform must not add to our deficits over the next 10 years — it must be at least deficit neutral and put America on a path to reducing its deficit over time. To fulfill this promise, I have set aside $635 billion in a health reserve fund as a down payment on reform. This reserve fund includes a number of proposals to cut spending by $309 billion over 10 years –reducing overpayments to Medicare Advantage private insurers; strengthening Medicare and Medicaid payment accuracy by cutting waste, fraud and abuse; improving care for Medicare patients after hospitalizations; and encouraging physicians to form “accountable care organizations” to improve the quality of care for Medicare patients.

            President Barack Obama

June 3, 2009

By the end of this decade, medical care will be delivered as never imagined by more than a few. No longer will you pay a doctor for his services. Instead, you will belong to one of thousands of Accountable Care Organizations (an ACO).

Your money will be paid to an entity whose job it will be to provide medical services to you and thousands of others from cradle to grave. You will pay a fixed fee that will be pooled and distributed as determined by the ACO to providers such as neurologists and other physicians. If they meet certain criteria, like fewer hospitalizations and lower medication costs, they will get bonuses. If not, they will simply be fired.

You will likely be tied to a long-term contract in order to control your behavior so that you get healthier and the ACO can show benefit to regulators. Otherwise the lengths that the ACO will go to in order make you healthier -like education or fitness programs-will show up on some other ACO’s achievement table. There are a few entities that approximate this type of program, such as Kaiser Permanente and the Harvard Pilgrim Plan, but unlike with future ACOs, participants float in and out, which is a disincentive for investing money in patients.

How will this affect the delivery of neurological care? According to the American Academy of Neurology, only about 7000 neurologists actually practice in the US, about 25 per million people. More and more are dropping out of hospital work because of high medical liability risk, poor reimbursements and the high demand in office practices because of the shortage. Consequently, neurologist availability will be a challenge for ACOs as Americans develop stroke and other diseases of the elderly in ever greater numbers. Not all ACOs, will be able to employ them, especially in smaller towns and rural areas.

Because nearly all of neurology relies heavily on patient history and observational exams (what the neurologist sees rather than touching or listening to the organs) and because treatments rely almost solely on medications rather than operations or procedures requiring proximity, telemedicine offers an excellent solution.

With salary, benefits, and other expenses, the cost of recruiting and retaining a neurologist is extremely high. If the neurologist is paid based on membership figures, a smaller ACO may not be able to support even one neurologist to handle the clinic, let alone cover hospitals for emergencies.

Alternatively, the services of a company like AcuteCare Telemedicine can be obtained for a small fraction of the cost, and can cover a larger number of patients in many different regions of the country sequentially or even simultaneously. Telemedicine specialists would only be called when needed, and because many ACOs would be employing the group on a fractional basis, the cost to each one would be far lower than that of hiring even one neurologist full time. Furthermore, studies show that patient satisfaction and stroke outcomes are as high as in-person consultations in urgent care situations.s

Teleneurology and the development of ACOs will have a mutually beneficial relationship in the coming years. Practitioners of this field will find a welcome home in these organizations and will help solve the coming shortage of neurologists in a new era of medicine.

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