August 6, 2024 | By: George Beauregard, DO, Chief Population Health Officer
Accountable: Required or expected to justify actions or decisions; responsible.
– Oxford Dictionaries
My career as an internal medicine physician started in the Boston area in 1992. Like almost all others whose ambitions lead them into health care, I was passionate and deeply committed to providing the best care possible for every patient I encountered.
The practice of medicine was distinctly different then. It was a fee-for-service world, without hospitalists, electronic medical records, telemedicine, accountable care organizations and other positions and systems we are familiar with today. At the hospital and physician practice levels, success was mostly defined by volumes of reimbursable transactions and total revenues for that work.
I really had no easy and reliable way of knowing how many patients with particular chronic illnesses I had, or how successful I was in getting patients toward treatment goals. I had no easy way of tracking patients who needed preventive care, or who
frequently missed appointments with me or specialists to whom I had referred them. I did not know which patients were at high risk for developing diabetes, heart disease, or obesity. I did not have evening or weekend hours. I was always available via an answering service.
The early stages of holding physicians accountable came with the emergence of managed care, in the early 1990s. Through contractual relationships with health plans, we were accountable to a medical expense budget without having any insight into how that budget was built nor how future budgets would be calculated. Part of the reimbursement to physicians was withheld and could potentially be earned back based on performance.
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