...these are the words of Dr. Donald M. Berwick, Administrator, Centers for Medicare and Medicaid Services on October 5th, 2010 as he was wrapping-up a workshop on Accountable Care Organizations in Baltimore.
Dr. Berwick was quoting Spiderman, trying to motivate and incentivize the gathered healthcare providers, attorneys, corporate executives and other stakeholders trying to figure out what the new rules of the game will be from the largest single purchaser of healthcare services in the world.
There is currently much interest among physical therapist private practices in the new Accountable Care Organizations that Dr. Berwick sees as new "...care delivery organizations, not as financing mechanism...".
Yet, there is little reassurance for private practitioners at the bottom of the referral nework that hospitals and large physician organizations will share the gains equitably if they become the "bankers" of the new ACO.
Ten years of research shows that physical therapy reduces costs and improves outcomes for high cost drivers like lower back pain.
Are there any assurances that physical therapists will become primary care providers for these patients? Won't hospitals have the incentive to under-treat these patients?
CMS is betting the farm on the cost-saving features of ACOs and counting on some, as yet undefined, quality measure to prevent undertreatment by hospitals.
Dr. Berwick finished up his speech by saying...
"Let me be clear, in closing, about one final, serious matter: authenticity.Tough talk - I like that - except that, when ACOs do arrive in two years, Spiderman won't be here to save us.
Those who wish only to preserve the status quo are not going to be constructive contributors to our nation’s future.
They cannot be effective partners, and we simply do not have time to pretend that they are.
We just do not have time for games anymore."