Chicago, IL (PRWEB) September 22, 2016
In a feature-length article published in its September 2016 issue, Medical Liability Monitor dives deep on whether clinical integration of the healthcare system – encouraged by the Patient Protection & Affordable Care Act of 2010 – is fulfilling its promise to reduce the risk of medical errors and lower the overall cost of healthcare in the United States. Medical Liability Monitor is a monthly newsletter that reports on the medical professional liability and risk management industries.
One of the priorities driving the Affordable Care Act is the need to rein in the exorbitant costs associated with the world’s most expensive healthcare system. The Affordable Care Act financially incentivizes physicians, hospitals and other ancillary entities to clinically integrate patient care across the spectrum of healthcare on the assumption that a greater coordination of care will curtail adverse medical outcomes, enhance the overall health of a population, reduce per capita costs and improve the overall patient experience.
Those entities able to demonstrate effective clinical integration are rewarded by the Centers for Medicare & Medicaid Services (CMS) with a share of the cost savings generated by increased efficiency. Evidence of effective clinical integration has also been used as a compelling tool for groups and health systems when negotiating contracts with commercial payors. Not only are CMS and private payors rewarding integration, a number of medical professional liability insurers are offering premium credits for clinically integrated physicians on the assumption that the improved coordination of care will equate to a lower risk profile. To date, there is little – if any – empirical data indicating clinical integration alone leads to an overall improvement in quality of care, a reduction in healthcare per capita costs of healthcare or reduce the risk of medical error, while there does exist evidence indicating that some of the requirements of clinical integration could actually create increased medical liability risk and facilitate the ability of dominant hospital systems to negotiate higher-cost reimbursements.
Increased clinical integration of the healthcare system holds potential to improve medical outcomes, reduce redundant testing, decrease medical error and trim the overall cost of care in the United States, but as with any systemic change, clinical integration also presents risk challenges as it ingrains itself into the overall American healthcare delivery system. It is important to recognize the magnitude of the changes occurring and anticipate the negative externalities likely to arise.
When medical liability insurers contemplate offering discounts to physicians for participating in a clinical integration program, they should consider if the discount is warranted based on the actual underlying risk. Insurers could be open to questions of whether this pricing is biased against (and at the same time alienates) their physician insureds with a comparable-or-lower risk profile but who pay a higher premium because they do not participate in a clinical integration program that carries a discount.
To read the unabridged article, “Does Clinical Integration Reduce Risk, Lower Cost of Care?,” please visit http://medicalliabilitymonitor.com/news/2016/09/does-clinical-integration-reduce-risk-lower-cost-of-care/
Founded in 1975, Medical Liability Monitor is the healthcare industry’s source for medical professional liability news, insight and commentary. Published monthly, MLM reports on the financial trends, insurer consolidations, tort reform legislation and premium data affecting the medical professional liability and risk management segments of the U.S. healthcare system.