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Thursday, July 29, 2010

Gaming the new system?

Last night I attended a program put on by the hospital about health care reform. The first speaker had clearly spent a great deal of personal time and energy working with folks who really didn't want the health care reform bill to pass. He had a good ole boy presentation style, peppered with sarcasm and full of predictions of imminent doom for the world as we now know it.  The only saving graces for his talk were that the food was excellent and that he used so much insurance and benefits jargon that the majority of the audience quit listening to him.

The second guy was more balanced.  He identified himself as a moderate republican, and though he didn't particularly like the health care bill as a whole, he presented a pretty balanced review, and looked at ways we could allow it to improve health care.

His major points included the fact that "accountable care organizations" (ACOs) are likely to become a dominant way to deliver health care, with their focus on coordinated care of patients from hospital to clinic to home. An ACO will consist of doctors, nurses, hospitals and supporting staff who will provide full spectrum health care for patients and be reimbursed based on the severity of the patients' illnesses and the quality of their care. Challenges for these organizations will be functioning in small communities and working out who gets what money for what job.

He addressed the idea that the bill would be repealed, and argued that it is extremely unlikely, even if the next administration is republican dominated, for that to happen. Many of the bill's early achievements will be so attractive to the majority of Americans, including expanded health care coverage for preventive services and to the uninsured or underinsured, as well as breaks for small business presently strapped by high health insurance costs, that dismantling the whole thing would be suicidally unpopular.

Apparently this second guy, a Washington lobbyist, will be working with our hospital to help us qualify for some of the grants available in the bill for organizations wanting to innovate in health care delivery. Many of these grants are particularly applicable to a small community such as ours, and could help us move in directions that we have discussed in the last year.