Breastfeeding Promotion and the Accountable Care Organization
Health care is not only becoming unaffordable to the average American family; it is also becoming unaffordable to the Government of the United States. As Medicare and Medicaid spending spiral farther and farther out of control, the federal deficit will inevitably reach the breaking point. The cost of medical care will continue to rise with increasing provision of services, each one of which demands its own separate fee.
The health care reform package proposes to solve this problem, at least in part, by changing the reimbursement paradigm: why not replace the volume-driven, fee-for-service model with a performance-driven model based on accountability of care? If the medical care system shifts its focus from numbers of patients treated to quality of care provided, the cost of care may return to sustainable levels. The emphasis will shift from treatment of disease to disease prevention and health maintenance, an orientation which will hopefully save the health care system millions of dollars every year.
One strategy for linking reimbursement to performance is the Accountable Care Organization (ACO). The ACO involves a partnership of primary care physicians, specialists, and a hospital (or hospitals) serving a given community in a manner that ensures cost containment and achievement of defined standards of high-quality performance. The Medicare savings realized from this approach will be shared with the ACO participants. Because the principle objective will be maintaining health rather than treating disease, the physicians most likely to benefit from the ACO will be primary care practitioners.
For primary care, breastfeeding support constitutes the quintessential health maintenance and disease prevention intervention. Billions of dollars could potentially be at stake. Traditionally, medical practitioners may have eschewed breastfeeding support interventions because they tend to be labor intensive, which as a general rule are poorly reimbursed. There is now an opportunity to turn this situation around entirely. If breastfeeding-related metrics can be included in performance standards upon which Medicare bonuses are based, there could quite conceivably be a very substantial financial incentive for physicians to become far more actively involved in breastfeeding support in their respective practices. The nature of primary care could be radically altered in a short period of time, and in a very favorable manner.
Our task now is to keep the importance of breastfeeding support front and center in the thinking of our policy makers. We need to educate the leaders of our professional health societies and the Centers for Medicare and Medicaid Services (CMS) that breastfeeding must not be overlooked if we truly wish to reduce the cost of medical care and safeguard the health of American citizens in the years ahead.
Jerry Calnen, MD, is a pediatrician and is president of the Academy of Breastfeeding Medicine.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.