Worrying about cellphones, ACOs and health improvement
Notes on the news:
There could be some promise for healthcare providers in last week's announcement that a World Health Organization panel has classified cellphones as “possibly carcinogenic.”
You have to approach this WHO pronouncement with some skepticism. The group didn't do any new research; it reviewed previous studies on radio frequency magnetic fields. The decision was based largely on epidemiological data indicating an increased risk of a rare form of brain tumor among heavy cellphone users.
Researchers these days come up with all sorts of theories, often conflating correlation with causation. People are panicked, only to be told later that another study reached a contradictory result. Health researchers still can't agree on what you should eat and how many glasses of water you should drink.
But if people start believing that cellphones cause cancer, maybe public health will improve—or at least emergency rooms will be less crowded. There could be fewer people obliviously walking into traffic with a cellphone pressed to their ear—and likely getting hit by a motormouth motorist on a mobile device. Maybe there would be a reduction in job stress from employees conducting business at all hours in all places. Waiting rooms would be quieter.
We may want to let this latest health scare linger awhile.
Speaking of scares, the government is being flooded with provider comments on its proposed accountable care organization rules. The overwhelming provider take is that they are too much of a hassle, are based on insufficient data, are not rewarding enough and are just plain unworkable. The head of the Cleveland Clinic, for example, called the ACO plans prescriptive, burdensome and discouraging.
The critics may be right, but their arguments sound like the latest cover of an old tune. Almost every proposed change to the nation's healthcare system in the past half-century, including Medicare itself, has met with similar cries. Each time, the industry survives and thrives.
For the opposite of the provider perspective, read an article by Paul Ginsburg of the Center for Studying Health System Change in the June 2 New England Journal of Medicine. Ginsburg argues that the complaints about ACOs are overwrought and that the CMS is rightly imposing high performance standards. He says the data comparison structure, financial rewards and quality measures are largely reasonable.
As Ginsburg notes, the ACO model is a reaction to the cost spiral caused by the fragmented fee-for-service system. It is a modest attempt—not for all providers to embrace early in the game—to achieve a rational delivery system over time and without massive disruptions.
There are harsher alternatives. Government and private payers could impose strict price controls as some other nations do. Then the ACOs will look a lot more palatable.
Meanwhile, there's room for quality improvement in the U.S. The Agency for Healthcare Research and Quality released profiles showing that five states—New Hampshire, Minnesota, Maine, Massachusetts and Rhode Island—topped the list for improved healthcare quality in 2010. On the other hand, the states of Kentucky, Louisiana, New Mexico, Oklahoma and Texas posted the smallest improvements in performance.
Note that in those underperforming states, anti-health-reform rhetoric runs high among some elected officials. Rather than spending resources on fighting reform, those officials could focus on improving quality and access for their citizens. And they could call their counterparts in the top tier for advice—preferably not on the cellphone.
Follow Neil McLaughlin on Twitter at twitter.com/MHnmclaughlin.
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