Wednesday, October 21, 2009

The Cost of Care, Part 5 of 5

The fifth and final section of the Dallas Morning News’ series called “The Cost of Care” featured the approach of Scott & White Healthcare (sometimes called “The Mayo of Texas”) to collaboration instead of competition, examined why primary care physicians may be choosing to move to other models of care delivery and what the U.S. can learn from other countries’ health systems. You can access the series here.

The first article in the final section of the series reports on Dr. Bill Walton’s final day in his 31-year-old popular family practice in Dallas. Walton is moving to Temple, Texas to join Scott & White as a salaried physician because of the pressures and costs of running his solo practice, also known as the “business of medicine.”

The Newsexamines why primary care doctors are “becoming an endangered species.” I have addressed this problem on my blog numerous times. If you are interested in some of my thoughts, you can hear them here. It is clear that the trials and tribulations of primary care doctors must be addressed if we are to provide adequate care to Americans, and especially if larger numbers of them will have insurance coverage in the near future.

The second article provides an in-depth look at the strengths and weaknesses of Scott & White, which is an accountable care organization (ACO) that uses salaried doctors and a team approach to deliver high quality care at a low cost. The company controls costs by managing all aspects of medical care, including health insurance, outpatient clinics and hospice centers. ACOs received quite a bit of attention this summer, as some health care reform proponents suggested them as a way to reward physicians for the quality of care they provide, instead of the amount of procedures they perform. We supported including a Super MEDPAC or Super IMAC if the organization had the power to evaluate ACO and cost-saving projects and suggest them on a large scale instead of having only the power to cut Medicare reimbursement rates.

Jim Landers, a columnist for The Dallas Morning News, also wrote a short column to round out this series that examined the health care systems of other developed countries around the world. None of them are perfect, he concludes, but many have found ways to spend less for equal or better care than that provided in the U.S. I have spent some time comparing our system to that of Great Britain and Canada as well. Like the U.S. health system, each has its own strengths and weaknesses.

My thanks to The Dallas Morning News for its in-depth and informative coverage of the health care industry in Dallas. Surely there was much more to discuss, but their staff did a wonderful job getting straight to the heart of the matter.

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