John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
What does accountable mean? The Oxford Universal Dictionary gives us a straightforward definition—“accountable: liable to be called to account, responsible; also, simply to be counted on.” As a physician, and consistent with this definition, I have always believed I am accountable for any advice given to a patient or action taken on their behalf. By extension, all of us at Fletcher Allen are collectively accountable for the care rendered at our facilities by our caregivers. However, this is no longer an adequate degree of accountability, as we are being called on to take responsibility for the quality and cost of care for populations of patients even when the care is provided by other physicians at other hospitals.
How is this possible? The federal government is incenting provider groups to take accountability for populations of Medicare beneficiaries through the formation of Accountable Care Organizations (ACOs). The idea is that if most or all of the different provider organizations in a region together take accountability for the health and heath care needs of the people in that area, quality will improve and costs will decrease. Fletcher Allen, in partnership with Dartmouth-Hitchcock Health and other provider organizations across Vermont, has formed a statewide ACO called OneCare Vermont with just these goals in mind.
I find many comparisons between health care and other industries tenuous, but let me give one a try in an attempt to clarify the ACO concept. Everyone would agree that Ford is accountable for the quality and cost of the cars and trucks produced under their brand. Yet, each vehicle is assembled from thousands of component parts produced by the myriad of companies with which Ford has contracted, but does not own. Ultimately, the quality and the cost of the product depend on smooth working relationships between the suppliers and the assembly plant. Ford’s entire production network has aligned incentives.
In forming OneCare Vermont, a broad network of Vermont health care providers has come together to take accountability for the health and heath care needs of a significant segment of Vermont seniors. Like the suppliers in my example, the providers are united not by corporate ties, but by aligned incentives to keep people healthy and deliver the highest-quality health care for the lowest possible cost. If providers are to be counted on to meet the health care needs of any of our citizens, OneCare or other provider networks will become an essential component of Vermont’s delivery system. That’s what accountable means.
John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
‘Accountable’ could also include ‘transparency’ – lack of which was evident when Todd Moore (SRVP @ FACH and Pres of VMC AND future CEO of OneCare??) would not provide a copy of FAHC’s application it CMS for the ACO for public information and review – though public funds (Medicare) are involved.
Meanwhile, there may be a for-profit problem in healthcare in VT:
http://vtdigger.org/2012/10/09/potter-will-profit-making-be-job-one-at-onecare/
Sunlight is the best disinfectant.
Thank you for your comment. Based on recent approval by CMS, we have now made the OneCare Vermont application available.
Regarding the for-profit questions raised by Mr. Potter, our VP of Accountable Care Church Hindes responded in VT Digger today: http://vtdigger.org/2012/10/12/hindes-will-profit-making-be-job-one-at-onecare-no-caring-will-be-job-one/
We appreciate that & look forward to reading the application. You have a big battleship to turn in terms of corporate culture, but that’s not saying it can’t be done.
http://burl-vt.addr.com/health-and-safety/Fletcher-Allen-Health-Care/Renaissance-Project-scandal/sidebar3.html
Outcomes are more important than incomes. Although the inpatient wards are ghastly and should have been addressed first, is it right to keep patient costs inflated for capital improvements? There should be more open discussion of this problem.
http://www.reuters.com/article/2012/08/01/idUSWNA250720120801
And perhaps it’s time for somebody in a leadership position to question the mad rush to regard Boomers as the next big market to come down the pike.
http://www.medscape.com/viewarticle/771329
Following the Wall St. mergers-and-acquisitions model may do for health care what it did to the US economy.
http://www.thedailybeast.com/newsweek/2012/10/14/david-stockman-mitt-romney-and-the-bain-drain.html
It would be good to justify adding another layer to the already bloated healthcare management structure of the region – with actual outcomes. So far that has not happened with VT Managed Care (using as an example true surgical birth rates as an index – high, despite the evidence for 15% optimal: income stream priority over patient-centered care. The same with vaginal ultrasound: no clinical justification for excessive overuse; and you should hear the complaints on the street. It is wrong to abuse patients this way for the sake of a bond rating.)
Keep writing, I read every post.
KH
Ouch. Iceburned by Fletcher-Allen.
FAHC loves to throw words around…worst academic fraud and now the unsafest hospital in the US…account for that!
An impressive share! I’ve just forwarded this onto a coworker who was conducting a little homework on this. And he in fact bought me breakfast because I discovered it for him… lol. So allow me to reword this…. Thanks for the meal!! But yeah, thanx for spending the time to talk about this matter here on your site.
More on accountability & transparency –
Todd Moore did provide a copy of the ACO application. And FAHC’s IRS form 990 is also available for public inspection on the wonderful ‘Guidestar’ site.
Transparency – Good!
BUT – on both the 990 and the ACO app, FAHC’s CFO claims that the hospital serves a population of 1 million people. There aren’t 1 million people in the entire state of VT The US Census Bureau’s latest figures show that even in the widest possible stretch of VT and NY counties in FAHC’s HSA, there are about 530,000. Surely the CFO can distinguish between regional population and unique visits.
What’s troubling about inflation on this order of magnitude (almost 100%!) is that it skews all the figures about FAHC’s cost-per-patient numbers; which, if based on the 1M population figure, are in reality twice as high as they now seem (i.e. in the Arrowhead Final Report, and in all of FAHC’s web advertising.)
Meanwhile a typical ER visit can now run $100 PER MINUTE. A ten-minute flyby visit with an FAHC PCP in a satellite clinic – where he spends most of his time looking at the computer, not at the patient – is $150. Surgical-birth and other overuse indicators (screenings, procedures) are off the charts. Vermonters spend among the highest per-capita costs for health care in the nation; yet we are supposedly the healthiest population. We are getting scalped.
Which brings us to another point: There is way too much marketing, publicity, and ‘social media’ going on, for very little benefit except increased patient costs. This has got to stop. Every time I hear an FAHC ad on the radio, or see one in print, there is a loud “KA-CHING” ringing in my ears!!
Change must happen faster. Vermont is where we could actually see this – if the focus is less on the C-suite and more on the patients.
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