Accountable Osteopathic Educational Organizations - AOEOs coming to a hospital near you!

So the buzz in the health care community right now is Accountable Care Organizations (ACOs).  The concept is an entity that is accountable for the care of populations of patients.  This entity encompasses hospitals, physicians, care management entities, home care, dialysis centers, etc., etc., etc.  The overarching goal is that there is improved value (quality and cost) to the patient.  There are multiple entities that are mentioned as shining examples of this model.  Critics proclaim that this cannot be done broadly and that we should not even try.

Apart from, yet concomitant with this trend is the discussions in Washington about accountability in graduate medical education.  This is coming, maybe sooner than we think.

Students of the game are well aware of the MedPAC report on the subject of accountability of Indirect Graduate Medical Education (IME) dollars.  There was a New England Journal Opinion piece from MedPAC on the same topic.  In addition, there was a front page article today in the Boston Globe discussing both decreases in GME funding from the Federal government and the lack of accountability in the current system.

What will accountability mean?  It is any one's guess, but if I had to read the tea leaves I would start at the Quality Compare web site mentioned in a previous post.  The Center for Medicare and Medicaid Services (CMS) has laid the groundwork for what it sees as transparency here.  It has also given a glimpse of the clinical metrics that it intends to use in the future in recent rules and proposed rules regarding Value-Based Purchasing (VBP).  The OGME world can expect educational metrics in the not-so-distant future.

Specifically, expect to see:  program size, program retention, board pass rates, graduates that practice in under served areas, graduates that practice within 25 miles of the training site, graduates of internal medicine and pediatrics programs that practice primary care.

Secondary, one may see:  does the hospital have an EHR, how much of the training is ambulatory, what are the procedure rates when applicable, is there training directly with other types of providers?

A next level may be:  continuous certification results for graduates, VBP results like HbA1C, LDL cholesterol, ACE inhibitors for CHF, etc. for graduates, state board of medicine actions for graduates.  Maybe I'm stretching, maybe I'm not.  If you were looking for a doctor, wouldn't you want to know how the program where he trained performs.  And by performs, you wouldn't really care how big the library is...would you??

The list is endless.  VBP is approaching 100 inpatient and outpatient measures, so, while I am being provocative, I am not wildly outside the box.

One additional note is that most of the VBP metrics have been vetted by and endorsed by the National Quality Forum.  There have been calls for a similar group for GME metrics.  It will be critical that OGME is represented at that table.

Change is coming!  It will make the present discussions look quite petty.  Are we ready??