Tuesday, July 5, 2011

Health Reform: Acronym Proliferation As A Sign of the Evolving Role of Community Health Centers To Serve the Growing Medicaid Population

We propose a novel care delivery system: Community Health Centers and Academic Medical Partners, or CHAMPS. CHAMPS would combine the subspecialist’s expertise, medical technology, and inpatient care of local academic medical centers (AMCs) with the primary care expertise of CHCs, utilizing an emerging subgroup CHCs known as teaching medical centers (THCs) to create a distinctive form of accountable care organization (ACO). We believe combining the best elements of AMCs and CHCs, these CHAMP ACOs could deliver high-quality, cost-effective care to low-income Americans while training the next generation of health-care professionals.

Richard E. Riesenbach MD, and Arthur L. Kellermann, MD, “A Model Health Care Delivery System for Medicaid,” New England Journal of Medicine, June 30, 2011

July 5, 2011 - One sure sign of growing government role in caring for expanding Medicaid populations is the proliferation of acronyms to explain what is going on.

This is apparent in the introductory paragraph to this blog. It contains 6 acronyms – CHAMPS, AMCs, CHCs, THCs, ACOs, and CHAMP ACOS. The paragraph does not mention CMS, the Center for Medicare and Medicaid Services, an acronym representing the most powerful and biggest delivery model of them all with $1 billion in federal revenues.

No Quarrel

I have no quarrel with use of acronyms or the organizations they represent. Acronyms serve a useful purpose – brevity- but they also add confusing bureuacatic alphabet soup to current efforts to reform health.

I applaud the noble ideas of CHAMP ACOs, which would theoretically.

• Use senior residents as primary care providers funded by Medicare.

• Eliminate billing costs and administrative costs through global capitation.

• Decrease hospital admissions and ER visits that could be treated on an ambulatory basis.

• Decrease hospital costs and admissions.

• Decrease laboratory and imaging costs because teaching programs would mandate appropriate resource use.

• Decrease fragmentation of care with effective access to and use of consultations.

• Protect against medical liability for CHCs under the Federal Tort Claims Act.

• Effectively manage prevention and management of chronic disease.

• Proved integrated dental and mental health services.

• Advance use of electronic medical records and medical home developments through use current federal programs.


Still, I am dubious about these propositions for these reasons.

1. They are theoretical and untested.

2. They assume academic centers have management skills they may not possess.

3. They assume CHAMPs ACOs would be immune to antitrust laws and malpractice.

4. They rely on federal funding and daunting set of regulatory challenges.

As the authors themselves say, “The biggest obstacle to CHAMPS is not financial, but regulatory. A recently proposed rule of the Centers for Medicare and Medicaid Services (CMS) will bar Medicare patients who get their primary care from a CHC from joining an ACO.

This can be overcome, say the authors, by assigning each THC patient to a primary care resident and a supervising physician. They add that working in a well –managed THC might encourage more primary care residents to join a CHC when they complete training, especially given the incentive of debt repayment through the National Health Services Corps (NHSC).

This may be. Certainly, it will take thousands primary care physicians to care for the 20 million Medicaid patients now cared for by Community Health Centers, soon to be joined in 2014 by 16 million more mandated by the Accountable Care Act, and perhaps even 20 to 30 million more if 30% of employers drop coverage for 80 to 100 million Americans, as a recent McKinsey survey of employers suggests.

I wonder if academic medical centers, their faculty and residents, outside practitioners, and patients themselves will understand how to navigate the acronymic jungle.


Acronyms aside, it is apparent to me Community Health Centers, which now serve 20 million Medicaid recipients, will continue, indeed, will have to grow when as many as 50 million more Americans come at board the Medicaid ship. There are now 3000 Community Health Centers, and there will soon be more. Some will be run by existing staffs of primary care physicians, others by nurse practitioners, still others perhaps by academic health centers. Whoever runs them, these Community Health Centers will be the bedrock model for delivering care to an exploding Medicaid population.

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