January 21, 2015

What Does Accountable Care Mean for Early Career Psychiatrists?

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Erika F. H. Saunders, MD

Penn State College of Medicine, Hershey, Pennsylvania


We are in the midst of a shift in the framework of health care delivery in America. Currently, most health care professionals in America are reimbursed for care provided, whether that service is for acute illness or preventive care, and reimbursement comes from the patient’s pocket, the insurance company, or the government. This model incentivizes health care providers to perform high-cost procedures and care for acute illness rather than provide preventive care and care for chronic illness.

A new model is emerging in the form of the Accountable Care Organization (ACO) and is often described as “population health care.” ACOs care for a population of patients with a fixed amount of reimbursement per member for a fixed amount of time. In an editorial in the October 30, 2014, issue of the New England Journal of Medicine, Dr Lawrence Casalino described the central goal of the ACO program as improving the value of care provided, defined by improved quality at a reduced cost. Dr Casalino also elaborated on potential pitfalls that may hinder development of the ACO movement and skewed motives that may hamper increase in true value of care provided. In the same issue, Song et al and McWilliams et al described the experiences of some of the pioneering ACOs, and, broadly speaking, these studies showed an improvement in quality and reduction in cost.

What will this movement mean for early career psychiatrists? Along with other fields, we will increasingly be required to demonstrate the quality of care that we provide. While providing high-quality care has always been paramount in medicine, how do we demonstrate that we are doing this? Using measurement-based care systems and demonstrating adherence to treatment guidelines are two ways to systematically measure quality of care in psychiatry.

I recommend that early career psychiatrists familiarize themselves with outcomes measures that can be implemented in routine clinical care. In the clinic, we ask our patients to tell us, for example, about their mood over the past 3 months. However mood, like pain, is difficult to remember accurately. When I introduce outcomes measures to my patients, I say that this measure will help both of us recall the specifics of symptoms at certain time points in the course of treatment, which will give us data to use in individualized treatment decisions.

At Penn State Psychiatry, we are implementing a systematic program of diagnostic and outcomes measurements to enhance clinical care and quality programs. Health care organizations will be increasingly interested in these kinds of data, as objective outcomes data can be collected in the aggregate to show outcomes by treatment provider or treatment setting.

Measurement-based care in psychiatry has been recommended by experts and called for in APA Practice Guidelines. Familiarity with published treatment guidelines issued through professional organizations or government health care systems abroad (eg, American Psychiatric Association, British Association for Psychopharmacology, Canadian Network for Mood and Anxiety Treatments, National Institute for Health and Clinical Excellence) is crucial for understanding the standard of care and for measuring one’s own treatment efficacy. Health care is changing, and being able to demonstrate quality of care will be increasingly important in psychiatry as in all of medicine.

Financial disclosure:Dr Saunders is a consultant for Profiles in Knowledge.

Category: Mental Illness
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5 thoughts on “What Does Accountable Care Mean for Early Career Psychiatrists?

  1. Couldn’t disagree with Dr. Saunders more. For how long do we have to keep bending over and taking it from the regulators and insurers. Only we physicians provide the care, and the system is useless without us. I’m tired of spending my time “accounting,” “justifying,” “proving,” and “measuring” as a data collector for some other business’s purposes. I’d rather just treat my patients and spend the time with them. If all the doctors (including “experts” who need to get out of their ivory towers) and professional organizations would begin to say “ENOUGH!!” and “We AREN’T going to do this crap anymore,” perhaps the tables could start returning to where they once were and rightly belong. Power to the doctors, not the middle men and greeds who all have their fingers in our pockets, but none of the training or liability that we take on….
  2. I like the concept that doctors should know what they’re doing–it has a nice ring to it. I greatly admire how insurers (might they contribute to politicians re-elections?) continue to portray themselves as caring, ‘we’re here for you’ outfits while simultaneously make more demands, change criteria and, in general, find ways for less reimbursement or none, if they can get away with it.
    Someone should write a science fiction story about how physicians begin not to take insurance and wrest control of patient care back–Hunger Games 4-Rebellion of the Docs.

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