Elizabeth O'Brien's Retire Well: Train your doctors to treat you right

By Elizabeth O'Brien, MarketWatch

Imagine youre remodeling your home. The plumber is installing the pipes, the electrician is running the wiring, and the roofer is laying the shingles. Problem is, theyre each doing their job in isolation, never talking to one another even though theyre working on the same project.

That would never fly on a building site, but thats the state of health care for most patients today. Despite working on the same projectyouphysicians and other medical professionals across different offices don't often communicate about shared patients. You almost dont have a general contractor to look over the whole thing, said Jennie Chin Hansen, CEO of the American Geriatrics Society.

By middle age, many of us have at least one chronic health issue. In 2009-2010, 21% of adults ages 45 to 64 had two or more chronic conditions, according to the Department of Health and Human Services. Among those 65 and over, that number rose to 45%. (Examples of chronic conditions common among older adults include high blood pressure, diabetes, chronic obstructive pulmonary disease and arthritis. Mental health conditions, such as depression and schizophrenia, are also considered chronic conditions.)

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And patients often see a specialist for each chronic condition, in addition to a primary care doctor. They go to someone for their kidney stones, someone for their diabetes, and someone for their cardiac condition, said Dr. Steven R. Counsell, president-elect of the American Geriatrics Society and Mary Elizabeth Mitchell Professor and director of geriatrics at Indiana University School of Medicine.

Heres the issue: A lack of coordination among all these medical professionals can result in a host of problems, including adverse drug interactions, conflicting instructions and duplicated tests, all of which can be hard on the health and the wallet.

The medical community recognizes the problem, and there are early, hopeful signs of change. The Affordable Care Act provided for the creation of accountable care organizations, also known as ACOs, which are groups of medical providers that have a financial incentive to provide more efficient care. Nearly 11% of Medicare beneficiaries are currently served by one, and the concept has also gained traction outside of the government program.

Medicare, which covers some 52 million adults ages 65 and over and those with certain disabilities, plans to introduce a chronic-care management code next year, allowing doctors to bill the government for certain non-face-to-face time they spend helping patients manage chronic conditions. Private insurers have also begun to reimburse medical providers for care coordination, whether thats paying the salary of a staff care coordinator or a paying a per-member monthly fee as part of a patient centered medical home, another model for improved primary care. Insurers are realizing that these upfront payments can save bigger costs down the line.

Historically, insurers have reimbursed medical providers per procedure, a payment structure that critics say lends itself to overtreatment rather than coordinated, efficient care. Doctors typically didnt receive any payment for calling another doctor on a patients behalf. And even if they did, many couldnt realistically do that for every patient, since a full-time primary care doctor in a single-specialty practice has a median count of 2,223 patients, according to MGMA-ACMPE, the largest membership association for medical practice managers in the U.S.

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Elizabeth O'Brien's Retire Well: Train your doctors to treat you right