"Hospitals Give Health Law Real-World Test"
Dale Johnson is Exhibit A for people who believe that the new federal health-care law has embedded in it the secret to better care for less money. Suffering from congestive heart failure, coronary-artery disease and diabetes, the 58-year-old former teacher was hospitalized five times last year at The Mount Sinai Medical Center here and visited its emergency room 12 times. Cost to Medicare: $43,849. This year—with the help of a team of doctors, nurses and social workers—Mrs. Johnson shows up for appointments, takes her medications and is managing her chronic conditions. She has been hospitalized only once and ran up only $6,796 in Medicare costs through late August. But there is an Exhibit B in the same program, a 65-year-old woman with cancer and mental-health problems who has missed 10 appointments and has cost Medicare about $70,000 this year at Mount Sinai alone, much of it from hospital visits she could have avoided if she had followed doctors' instructions. "She's a great example of a kind of patient that poses a great challenge for us as we try to avoid unnecessary costs," says Jeffrey Farber, MD, a Mount Sinai medical officer. Mount Sinai's experience with patients like these provides an early glimpse at one facet of the federal health act in the real world. The women are part of a so-called accountable-care organization [where] hospitals or groups of doctors contract with insurers to provide care for an assigned patient population. The aim: better care at lower cost. Mount Sinai's experience to date shows some of the promise and pitfalls of the ACO. Based in Manhattan, it applied for Medicare's ACO program largely because "we wanted to position ourselves for what we think will be the future of reimbursement," says Kenneth L. Davis, MD, President and CEO of The Mount Sinai Medical Center. Learn more