Accountable care. That’s one of the central pillars of healthcare reform/Obamacare/the Affordable Care Act. Given that Obamacare is built on transforming Medicare, the payment system from which all Holy Billing Codes and the pricing attached thereto flow, Accountable Care Organizations (ACOs) would seem, given their name, to be about accountability for care, right?
Not so fast. The “accountable” in ACOs has more to do with accounting than accountability. An ACO is defined as a network of doctors and hospitals that shares responsibility for providing care to patients. In essence, that network agrees to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. The ACO is indeed accountable for providing care, yet that 5,000-Medicare-beneficiaries-for-three-years is as much about accounting as it is about patient care.
Real accountability in healthcare is an elusive thing. I’ve said many times, here and elsewhere, that there are no guarantees in medicine, other than that there are no guarantees in medicine. That does not mean, though, that we should expect mistakes. Medicine is a human effort, with human failings embedded within it. We should help ourselves, and the medical-industrial complex, though, by taking advantage of the information available to us – patients, providers, all of us – to determine where to get the best and safest care.
Accountability, in the accountable-actions definition, was codified in a California law that went into effect on January 1, 2007. That law gives the California Dept. of Public Health the power to fine hospitals up to $100,000 per event for what they call “immediate jeopardy”, which is defined thus: An immediate jeopardy is a situation in which the hospital’s noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient. A situation is an immediate jeopardy at the time it occurred.
Let’s play Immediate Jeopardy! I’ll take Medical Errors for $100,000! And the question is, “How much were California hospitals assessed in the most recent immediate jeopardy bitch-slap, Alex?” [the answer is in the blue tile]
Since the California law went into effect, 254 immediate jeopardy errors at 141 hospitals have been identified and fined, for a total of $10.4 million. $7.6 million of that has been paid. An article on Health Leaders Media gives the full story on the most recent round of errors, and the fines assessed. There’s also a link to the California Dept. of Health site, where all the incidents and fines since the law went into effect are available with just a few clicks. Some of those reports are truly alarming, even though they’re written up in very spare prose.
Here’s where becoming an e-patient delivers solid value: you learn how and where to look for reliable metrics on healthcare. Anyone can be an e-patient. Here’s how it worked in this instance, when I wanted some additional context for what I read in Health Leaders.
I read the article, and then, in a new browser tab, surfed over to a recent post on e-patients.net about the new Hospital Safety Score tool from The Leapfrog Group. I hunted up the safety scores – which run on an A through F scale, just like a school report card – for the 10 hospitals fined in the most recent round of Immediate Jeopardy. What I found was this:
- Five of the fined hospitals were A-rated, yet one of them was fined at the highest level ($100K), twice, for repeated incidents
- Of the other five facilities, two had B grades, and three got Cs
What did I take away from this dive into the medical-quality-metrics pool? What I take away from each dive I make into the healthcare ocean: transparency in healthcare is still in its infancy, but it’s getting clearer and clearer every day. Will it ever be crystal clear, letting patients make choices that are 100% guaranteed to have a great outcome? Please re-read the 3rd graf of this post for the answer there (hint: it’s “no”).
What we – patients, providers, payers, all of us – can do to make healthcare as clear and careful as humanly possible is to continue to call for immediate reporting of problems, to participate fully in each transaction we have with the industry, to share lessons learned when outcomes don’t match reasonable expectations. By helping each other heal the system, we can help heal ourselves in the process.