There is no question health care spending is a critical issue.   Approximately 17 % of our gross domestic product is related to expenditures in health care, an amount that’s seen a steady rise.

Health care reform was proposed as a solution to the rising costs, but Steve Espinoza of the Hospital Association of San Diego and Imperial County warns the road ahead is clouded with fog and haze.

Take Accountable Care Organizations for example.  Espinoza explains them this way, “It’s like a unicorn, everyone knows what it is, but no one has ever seen one.”

What is Health Care Reform? The Health care reform is a 10 year process, with a watershed year being 2014, assuming the constitutional challenges are met and an individual mandate to buy insurance or face a penalty survives.

Accountable Care Organizations are one part of the plan.  Put simply, ACO’s are a way to reduce costs, by reducing unnecessary tests or procedures.  Those in the organization would share the cost savings and the potential risks of getting less reimbursement for undesirable outcomes.  Another major goal is to reduce hospital readmission rates within a 30 day period for the same diagnosis.

Espinoza likens the idea to a TV Manufacturer, say Sony for example.  Sony uses lots of different vendors for the parts… but it assumes liability for the entire finished product, the TV.  Accountable Care Organizations would work the same way. There would be lots of groups involved, but one over-riding organization that would bear the risk and share the reward.

Organizations would bundle care, like primary care, specialists, home health and hospital care.  Patients would be able to opt out of the ACO if they wished.

The first proposal for Accountable Care Organizations was met with fierce resistance from health care providers.   That outcry over burdensome and unrealistic rules led to another set of rules that providers now feel are more manageable.

But the devil is in the details.  The Health Care Reform bill that was approved in March of 2010 dedicated only 6 pages to Accountable Care Organizations, according to Espinoza.  But the proposed rules now take up 690 pages.  The costs of starting up an ACO have been quoted anywhere from $1.5 million to much higher.

To help provide some guidance, the California Hospital Association in early November put out a 15 page summary.  The first ACO’s are slated to start on April 1, 2012.

There is also a community based plan in the works. The Aging and Independent Services in San Diego department is working on the San Diego Care Transitions Partnership.  This is a partnership that engages hospitals, nursing homes, home health agencies and other care providers across the continuum of care to prevent avoidable hospital re-admissions.   It’s a response to a solicitation for the Community-based Care Transitions Program, mandated by section 3026 of the Affordable Care Act.  AIS is partnering with Scripps, Sharp, Palmomar Pomerado and University of California San Diego Hospitals along with other providers such as home health and home care. The measurable commitment is to reduce the readmission rate for Medicare beneficiaries by 20% between January 1, 2012 and December 31, 2017.

The county is seeking charter members of this partnership.  Here is the partnership agreement for those who would like to be involved. Please click on the following link to download the form.  SanDiego_CoalitionCharter_Final