As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other docs will simply ignore what is being played out right before their very eyes, expressing the same willful blindness that some of my breast patients would, presenting with huge, fungating cancers.
It is understandable that doctors would want to hang on to a health care belief system that they embraced in medical school. But many of the beliefs of years past do not work today; try not to believe everything you think. Consider these five examples.
1. I am too busy to learn how to improve. Actually, you can’t afford to not learn. As we have discussed multiple times in these pages, our current system of health care finance is unsustainable. We are broke. For that reason, fee-for-service is going away. This means you will be at financial risk for populations of patients. You can’t just change one day. You need to learn how to improve quality and reduce costs. This requires new skills.
2. I make a lot of money, and that means I am really smart. Yeah, right. Like that failed limited partnership that cost you $500,000? Or how about both of those alimony checks that go out every month, regardless of your income? We know folks who have had stellar careers who still work in some capacity because they squandered their money. Anybody can learn how to do a colonoscopy or fix a hernia, so don’t get on a high horse because you have been blessed to have a good income. The future comes with significant uncertainty. Be a good steward and be grateful. If you think that you can win going against the forces that be, it could be disastrous.
3. My hospital loves me because I make them tons of money. Really? How do you know that? You would be surprised. I have a friend who was bragging about how much money he made for the hospital doing MRIs. It turns out that they lost $150 every time they turned the machine on. Or what about the $46M service line that cost $48M to run? I guess they will make it up on volume, right?
4. My performance benchmarks are OK, so that means my quality is good. You are two clicks to the green side of the benchmark, but that doesn’t mean you have good quality. It just means you are better than 52 percent of your peers. Plenty of people will stay there at 48 percent. Time to go to #1 above and learn how to get better outcomes, and in the process, you will also reduce costs. Your patients deserve it.
5. I will always have my choice in where I work. Don’t bet on it. Everyone is replaceable. You need to protect your career. Embrace team concepts of care. Develop leadership skills. I recommend that you start thinking now about how your work will change when you and your hospital or clinics take on more financial risk. Remember that lower costs of care are becoming indicators of higher quality. Don’t be the jerk that gets fired.
Tommy Prewitt is director, Health Care Delivery Institute, HORNE LLP.
