American healthcare desperately needs ACOs and coordinated care organizations

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We’ve had massive changes in healthcare since the 1990s — some positive, but most negative.

    • Hospital admissions have decreased (average daily census decreased 31% from 1980 to 2010, while the US population increase 36%) with recent massive staff layoffs in leading medical centers and healthcare systems and closure of many hospitals.
    • Hospital Outpatient revenues decreased from 7.4% in 1995 to 0.5% in 2011.
    • Percent growth of US healthcare costs peaked at 8.5% in 2003 and decreased to less than 4% since 2009.
    • Physician visits peaked in 2005 – now decreasing 2M/year –14% in 2010.
    • High deductible health insurance plans increased from 5% of the market in 2008 to 20% in 2012.
    • Emergency departments are overwhelmed.
    • The US healthcare system has stagnated and ceased to innovate
    • Pharmaceutical company sales growth deceased from 20% a year in 1999 to minus 2% in 2012.

    Politicians and governmental bureaucrats have starved our healthcare system and driven major healthcare restructuring with excessive legal and regulatory restrictions and requirements. They’re destroying good aspects of our healthcare system and decrease healthcare costs by shifting those costs to us and to future generations. They have no understanding of our uniquely American healthcare system.

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    Healthcare has evolved from a service profession to a big, largely government driven business consuming 18% of our GNP. Our healthcare is inefficient and costly and no longer responsive to OUR choices and to free-market forces. We’re being forced to live by rules made by bureaucrats who are far removed from providing care and don’t have to live by their own rules.

    Washington is stagnated by radical polarization. Both parties are big government parties that focus on their special interests, not OUR interests. Meanwhile, most of the American people want our government to work and reach meaningful solutions not to continued political posturing!

    Most of us understand that we can’t sustain the deficit spending and growing debt that OUR government is imposing on us and on our future generations. Most are also socially moderate and believe in tolerance of other people’s personal views, philosophical and religious beliefs, as long as those beliefs are not forces on us. The free market place of ideas and the values of our Founding Fathers have made us a great nation. We must hold onto those values and work with both sides of the political isle to make meaningful compromises. It will not be easy, but it must be done. Not only for meaningful healthcare reform, but for our system of government to survive and prosper.

    Healthcare is highly complex. We should start reform with issues most agree on:

      • Individual freedom of choice for health insurance
      • More universal healthcare insurance coverage
      • Insurance for pre-existing conditions
      • Implementation of advanced health information technology systems
      • More efficient coordination of our personal healthcare, including health promotion and wellness programs for disease prevention and special programs for chronic disease management
      • True transparency of healthcare information on costs, quality and options for services and procedures to facilitate more informed decisions
      • Convenient and timely access to healthcare providers that provide quality healthcare. We should be able to choose a healthcare provider as easily as we can choose a good restaurant using an “app” on a smart phone

    How do we get there? We should demand that our leaders address OUR issues with healthcare and move forward with meaningful healthcare reform to:

      • Decrease the exceptionally high administrative and overhead costs of healthcare
      • Enable providers to spend more time with patients and practice more efficiently and cost-effectively
      • Involve more providers and patients in healthcare reform decision-making processes
      • Correct wide and unjustifiable variations in healthcare quality and costs by providing data to support informed choices — let choice and free market forces drive high value options.
      • Promote personal responsibility for health through wellness and health promotion education programs, with incentives for healthy behaviors and improving individual outcomes.
      • Implement Accountable Care Organizations, Coordinated Care Organizations and Patient-Centered Medical Homes – Healthcare team-base approaches focused on patients with difficult, expensive problems can improve quality of care and decrease costs by avoiding hospitalizations and emergency department visits.

    We should consider comprehensive, bi-partisan, market-based solutions — see “Michigan’s Approach to Medicaid Expansion and Reform” (N Engl J Med 2013, 36; 19: 1773-1775). It’s a rational, cost-effective healthcare reform plan linked to free market incentives and innovations. It is a much better approach then the Affordable Care Act that is proving to be extremely expensive and unworkable.

    We The People must demand that our political leaders move forward with OUR healthcare agenda, not their multiple, conflicting special interest political healthcare agendas. They must work together to find solutions for OUR most pressing healthcare problems.

    Copyright 2014 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

    Earl W. Ferguson, MD, PhD

    By Earl W. Ferguson, MD, PhD

    After graduating from the University of Texas Medical Branch with MD and PhD degrees, Dr. Earl Ferguson completed his training in at Duke University Medical Center. He was on the faculty of the Uniformed Services University of the Health Sciences and a senior executive managing hospitals, medical centers and healthcare systems, as well as Director, Aerospace Medicine and Occupational Health for NASA. Ferguson currently works in a remote, rural hospital developing and implementing telemedicine and other health information technology applications.
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