ACO model won’t cure health care woes

Regarding “Health care improvement group launched” (Tribune-Herald, May 24): Mr. Barry Taniguchi’s quest to transform health care and engage the community in Hilo is laudable. There certainly is a lot of room for improvement.

To begin with, we desperately need more specialists. Perhaps his organization could help us recruit them?

That would immediately improve the quality of health care for our patients and save them a lot of expense traveling back and forth to Honolulu. It also would reduce costs for some insurers, including Quest Expanded Access (aka Medicaid, taxpayer-funded), which currently pay for interisland travel without entering into a complex arrangement, such as an ACO (accountable care organization) to which he alludes.

Listening to national expert Harold D. Miller recently, one is easily persuaded to believe the main cause for the meteoric rise in health care costs during the past couple of decades has been the “fee-for-service” system. His conclusion is incorrect. Reimbursements for professional services actually have changed very little through the years. What has changed (and these are the white elephants in the room) is the rapidly escalating costs of pharmaceuticals and modern medical technology. At present, these account for approximately 20 percent of health care spending. There appears to be no end in sight.

Fee-for-service providers (including, but not limited to, physicians, physical therapists, occupational therapists, hospitals, etc.) are convenient scapegoats that easily can be bullied into submission with threat of penalties and cuts.

In the 1980s and ’90s, efforts to transform the system by creating HMOs (health maintenance organizations) eventually failed. Trending now is the concept of PCMH (patient centered medical home, whatever that means) and “meaningful use” (or meaningless, depending on your point of view). These are concepts that Centers for Medicare and Medicaid Services has been persuaded to adopt by a brigade of health care consultants, such as Mr. Miller.

An ACO is yet another experiment in this continuum. In Hilo, it is being actively lobbied for by an organization called Pono Health, which is developing metric software to gauge quality of care that it eventually hopes to sell to insurers to measure outcomes. We, here in Hilo, are being asked to serve as guinea pigs for this experiment.

The Affordable Care Act, commonly referred to as Obamacare, only has succeeded in driving up costs. The Hawaii Health Connector continues to hemorrhage taxpayer revenue. HMSA publicly stated it sustained losses amounting to several million dollars last year as a direct result of being mandated to provide extra services by the ACA.

That results in increased premiums and co-payments, which, of course, are a matter of serious concern to large (such as Mr. Taniguchi and KTA) and small (such as myself) employers. I notice that my health insurer tagged on an “ACA fee” to my health insurance premium!

When President George W. Bush signed Medicare Part D (prescription drug) benefits into law, bowing to the immensely powerful pharmaceutical lobby, he did not impose any restrictions on the cost of prescription medication. To the insurer, the average monthly price of a branded medication is a staggering $200!

Organizations such as Kaiser Permanente and the Veterans Administration, by virtue of numbers, lower their costs by collective bargaining. To President Obama’s credit, he is proposing something similar to lower costs for Medicare, but has met with stiff resistance from both major political parties, backed by lobbyists.

In Hilo, we should not be wasting our resources trying to implement an ACO, which will not be a “win-win-win” situation for all.

There might be winners, such as Mr. Miller, who was paid $100,000 by a consortium to visit Hilo, and who stands to make a lot more from HMSA, East Hawaii IPA and Hilo Medical Center should he be retained as the consultant; as well as Pono Health, which manages East Hawaii IPA.

But I doubt if providers, including our already cash-strapped hospital, will be among the winners as the grips of the vice are further tightened. Whether patient care will truly benefit, remains an open question.

Instead, we should raise the finances, with a public-private partnership with contributions from all health insurance companies (reduced expenses), public and private employers (reduction in premiums), nonprofit organizations such as Community First and East Hawaii IPA (which might or might not see the wisdom of this proposal, depending on whether or not Mr. Miller is advising them in this matter), as well as the community (which is most affected), to recruit “specialists” to Hilo by paying them premium dollars to get them off-and-running.

Something as simple as that has the potential to transform health care in Hilo and have far-reaching consequences. It is a far more economical and pragmatic way to provide excellent health care and reduce costs rather than experimenting with the complexities of an ACO.

At a great financial cost, Hilo Medical Center already has been doing this for our community for many years. For the benefit of our community, HMC quietly has recruited primary care physicians, as well as key specialists, to fill in the gaps in care — at a financial loss.

Unbeknownst to most, Hilo Medical Center also has been paying our non-HMC-employed community specialists a fee for simply being on call for emergencies. Essentially, our cash-strapped hospital is subsidizing specialist care in Hilo.

It is time for the community to pick up the tab. That, in my opinion, would be a “win-win-win” situation!

Mr. Taniguchi, with all his political connections, enormous respect and adoration, can get the ox cart moving in this direction.

I say no to the ACO!

Hilo physician Pradeepta Chowdhury is a diplomate of the American Board of Internal Medicine.