Journal of general internal medicine
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General internists need to take an active leadership position in the creation of accountable care organizations (ACOs). The basic idea behind ACOs is relatively simple. Physicians, hospitals, and other health care providers will continue to be paid fee-for-service by the Medicare program, but if they can work together to better manage people with chronic conditions, reduce avoidable complications, reduce unnecessary specialty referrals, and improve transfer of beneficiaries as they transition from one care provider to another; then there is the possibility of shared savings with the Medicare program. ⋯ They should be involved in identifying the patients that would benefit from better care management. They should identify changes in care processes and payment reforms that would improve the care for these patients. ACOs represent an opportunity for general internists to change the way medical care is delivered.
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The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use. ⋯ In a representative sample of Medicare beneficiaries, despite low income and health status, veterans with dual Medicare/VHA use were as likely as veterans without dual use to have any ACSH, perhaps due to expanded healthcare access and emphasis on primary care in the VHA system.
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For many high-risk patients, accessing primary care is challenged by competing needs and priorities, socioeconomics, and other circumstances. The resulting lack of treatment engagement makes these vulnerable patient populations susceptible to poor health outcomes and an over-reliance on emergency department-based care. ⋯ Tailoring the medical home model to the specific needs and challenges facing high-risk populations can increase primary care utilization and improve chronic disease monitoring and diabetes management. More work is needed in directing this care model to reducing emergency department and inpatient use.
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Hospitals face increased pressure to improve their quality of care in an environment of dwindling hospital payments. It is unclear whether lower hospital margins are associated with worse quality of care or closure. ⋯ Low hospital margins are associated with worse processes of care and readmission rates and with changes in operating status. We should monitor low-margin hospitals closely for declining quality of care.