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Can Obamacare take care of 'Joe?'

By   /   July 26, 2012  /   6 Comments

By Kirsten Adshead | Wisconsin Reporter

MADISON – Somewhere in Wisconsin, there’s a guy who, Dr. Brian Ewert says, represents the American medical system’s strengths – and weaknesses.

The patient, given the made-up name of ‘Joe’, also exemplifies how Marshfield Clinic has cut hospital bills by $4 million, by committing to a care coordination program aiming to help patients get the acute care they need without relying on expensive emergency services, said Ewert, the clinic’s president.

Ewert spoke Thursday as part of a panel of Wisconsin health-care industry executives about the impact of the Patient Protection and Affordable Care Act – an impact, they said, that could prove positive.According to Ewert, Joe used to show up at Urgent Care on almost a daily basis – until Joe was assigned a care coordinator who checked in with him regularly.

Joe did come to the Emergency Room one night, however, and got what Ewert called “his usual routine” before being sent home. But when the care coordinator called Joe the next morning, something seemed off.

“She talks to him and by the end of the conversation says, ‘Joe, why don’t you come on into the clinic?’ … so that later that night he could have his appendix removed,” Ewert said.

“So, that’s the perfect story,” he said. “Joe stopped going to Urgent Care, looking for love in the wrong places, and actually knew when to access the system – and then the system almost failed him,” Ewert said. “So that’s where, what we’re learning now, as opposed to the ’90’s, is how to take care of Joe.”

‘Obamacare,’ now what?

Ewert and his fellow executives were invited to Madison to discuss the federal health-care reforms, which the Supreme Court ruled constitutional four weeks ago.

The Affordable Care Act, also known as Obamacare, makes sweeping changes to health-care delivery in the United States, including requiring insurance companies to provide coverage to those with pre-existing conditions and requiring individuals to buy health insurance.

Supporters say the ACA protects people who can’t afford, or get, health insurance.

Opponents, however, see the program as a prime – expensive – example of government overreach.

Gov. Scott Walker is one of a handful of governors who has said he would not implement the health-care law until after the November elections – hoping that Republicans will win the White House and both chambers of Congress and that the GOP then will be able to repeal the law.

None of the health-care executives spoke out in direct favor or opposition to the law Thursday.

But they did find promise in provisions of the ACA that give incentives for joining Accountable Care Organizations, which are groups of health-care providers that aim to improve care while cutting costs by sharing services and savings and tie payments to patient outcomes.

“Part of the ACA is an increased requirement from the (Internal Revenue Service) to focus on community benefit,” said Dr. Dean Gruner, president and chief executive officer of ThedaCare, a health-care system in northeast Wisconsin.

As a result of that provision, he said, “We’re going to be forming more public-private partnerships with other entities and with other public health organizations in our communities to work on issues that we can solve by ourselves within our health systems.”

Dr. Craig Samitt, president and chief executive officer of Dean Health System, said Dean Health has embraced ACOs.

“As organizations are rewarded for better care, not just more care, I think there’ll be much more attention to the quality of performance, the service performance, the variation in our practices from organization to organization,” Samitt said.

A recent piece in Pharmaceutical Executive magazine titled, “ACOs are Here to Stay, Even if the ACA is Not,” noted the relative fragmented nature of the U.S. health-care system.

“A continuing trend toward ACOs could make the system even more fragmented by introducing ACOs as price-sensitive stakeholders,” the article asserts.

To be successful, ACOs will need to monitor their budgets closely and identify cost-effective protocols and policies at the system level, argues the magazine. Each individual ACO will be making tradeoffs between different possible treatment regimens and evaluating whether newly available treatments could help increase efficiency.

“At a minimum, this would result in significant variation across ACOs in the early adoption rates of new healthcare technologies (e.g., drugs, devices, or diagnostics),” the piece states. “And unless ACOs share approaches with each other, there is potential for long-lasting variations from organization to organization.”

‘Game-changer’

Stories like Joe’s, the Affordable Care Act and ACOs all represent what is a complicated, uncertain future for health care in America, the executives said, which they agree is a broken system.

Among the concerns: The current system costs too much and cannot be sustained, puts too little emphasis on staying healthy, doesn’t target physician care to those who need it most and is stuck in a fee-per-service model instead of linking charges to patient outcomes.

If the ACA stands, many questions remain in its wake, which will be answered state by state.

The chief executives said, however, that regardless of the ACA’s outcome, something has to give with the American health-care system.

Dr. Randy Linton called the transition into a quality-based fee system a “game-changer.”

“The need to be able to move from the concept of paying for volume, for what we do, to be able to pay for outcomes in value and quality is an absolute, fundamental requirement for us to move forward,” said Linton, the Eau Claire president and chief executive officer of Mayo Health Clinic System. “It drives the disparities and the inconsistencies that we clearly see when we look on a national scale.”

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  • Mary

    Obamacare still needs to be repealed. HHS has control over your doctor and your medical outcome and the IRS has control of you. The above changes can be done without government control.

  • Fran

    You have a voice don’t you? Your doctor does NOT control the services that you are entitled to – where do you come up with this stupidity? We as Americans will ultimately be saving money – the figures were published this week – wake up. The current system is costing us huge tax dollars every day – spend some time educating yourself instead of hating the Affordable Care Act simply because President Obama has accomplished something the repubs have refused to address. If you want to live in America we have to work together for the benefit of everyone or we will surely perish as a society. Time for you and others of like thinking to read the Affordable Care Act and ask questions when you don’t understand – which apparently you do not.

  • Bobbi

    All I can say is that had I gone to the clinic in Sept. 2005 and not ER, I would not be around typing this right now. A large tumor was found on my pancreas after spending 14 hours in ER and after many tests. I went in for indigestion and back pain. ALL the doctors at the hospital said my tumor would not have been caught at the clinic and would have continued to grow, eventually causing a blockage and killing me! It was fortunately benign but most of my pancreas was removed along with my spleen by the time it was caught. I had previously gone to the Clinic for those symptoms more than once over 2 years and was just given meds for the indigestion and the back pain and then sent home. It wasn’t until I woke up unable to walk that I decided to go to ER!

    Would Obamacare have allowed that and all the tests ER did to get to the bottom of things? I think not.

  • Mary

    Fran……HHS will set protocols as to how your doctor will treat you. If you have your own insurance your premiums will go up if they haven’t already. Who do you think pays for all the “free treaments” HHS has said insurnace companies must provide?! PLUS, there are 21 new taxes within Obamacare that will raise your taxes at least $3000. So, you wake up and read between the lines. NOTHING IS FOR FREE!

  • Fran

    I pay for my own insurance, I pay my own bills but I also speak for myself when I have a problem – if a doctor tries to dismiss my concerns I address their poor attitude immediately. You are currently paying dearly for all the uninsured that access their health needs via the ER. That cost will dramatically decrease when these folks can regularly access health care through normal channels. I never implied that anything is free. When I started my own business many years ago I was paying $1500/month for my premiums so that I would be assured that I could take care of myself. Stop listening to all the fear mongers out there. We need to fix our health care system and this is a good start. It sounds like you are the one complaining about having to help carry the system. In the end we will all benefit – give it a chance – it’s better than the current system. Perhaps when you have your first catastrophic health experience you will start to understand.

  • Mary

    That’s just it Fran….Obamacare CANNOT cover catastrophic heath for millions of Americans….it’s geared tward preventive. It should be catastrophic. I have a business too and was paying $1600/mo for insurance….switching to an HMO and having an HSA helped tremendously. But now HSA will no longer be deductible. You also fail to address the fact that there will be a shortage of doctors because there are many that will quit, especially the older doctors…..the ones we trust the most. ALL American are carrying the current system. And will continue to carry the system since the latest CBO report claims that now 30million Americans will be without insurance because many states will not take part in Medicaid. Congress should have started reforming healthcare baby steps at a time..,….not shoving this HUGE tax inrease on Americans. Do read about all the new taxes created with Obamacare…..you won’t like it.