• Reflex: October 21, 2011

    Some health care providers may be happy with the ACO rule, but insurers are not, reports Julian Pecquet (The Hill). “The insurance lobby raised concerns that the new rules weakened antitrust protections that prohibit extreme consolidation in the healthcare sector. Insurers say they’re falsely accused of driving healthcare costs up when large hospital systems with too much pricing clout are to blame.” Austin’s comment: This is precisely the concern I’ve raised many times, going back to the summer of 2009. ACOs may make sense for Medicare. They may not, by themselves, help solve the health care spending problem for the private sector.

    Country doctors fill a huge need, writes Blythe Bernhard. “Most of the country’s doctors don’t want to be country doctors. Only 3 percent of medical school students say they want to practice in rural areas, according to research from the University of Missouri-Columbia. That’s a problem for Missourians, because 30 rural counties in the state qualify for federal designation as health professions shortage areas. More than 40 counties have no hospital. Eight counties have just one medical doctor, according to the state board of healing arts.” Aaron’s Comment: For all the talk of the value of “real America”, we aren’t doing a very good job of providing health care there. One more problem with having too few doctors.

    Long Term Care groups react to ACO rule, writes McKnight’s Long Term Care news. The reduction in number of quality measures that must be reported from 65 to 33 was welcome news for LTC providers who have many such requirements. Don’s comment: Including and integrating LTC providers into ACO’s will be important if the cost of some of the most expensive patients in the system is to be addressed while improving quality. An especially important and difficult issue is addressing rehospitalizations in a reasonable manner, and LTC providers will have to be part of the solution. A related issues will be the need to integrate palliative care and hospice.

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    • My group is expanding to provide coverage in some, very, rural areas. It makes for quite a challenge. Lots of driving. The tough part is the call coverage.

      Steve

    • The changing gender mix also doesn’t help increase the supply of rural physicians.

      Highly educated women are even less likely than men to live and work in rural settings, and as the percentage MD’s that are female increases, this problem will only intensify. (There’s a 2000 or 2001 paper in pubmed that provides some quantitative data which establishes the magnitude of this effect).