October 7th, 2011 by BobDoherty in Health Policy, News
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Last week, Medicare’s Center for Medicare and Medicaid Innovation announced a Comprehensive Primary Care (CPC) Initiative, which asks private payers and state Medicaid programs to join with Medicare to “help doctors work with patients to ensure they:
1. Manage Care for Patients with High Health Care Needs;
2. Ensure Access to Care;
3. Deliver Preventive Care;
4. Engage Patients and Caregivers; and,
5. Coordinate Care Across the Medical Neighborhood,”
according to an email from CMS’s press office. The initiative will provide qualified practices with risk-adjusted, per patient per month care managements payments, in addition to traditional fee-for-service payments, along with the opportunity to share in savings achieved at the community level.
I believe that the Initiative is a potential game-changer in helping to support and sustain primary care in the United States. But Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 2nd, 2011 by Dinah Miller, M.D. in Health Policy
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Over on Shrink Rap News, Roy wrote a post about proposed Medicare cuts. He continued the conversation here on Shrink Rap.
I want to expand on the discussion in what I hope will be easy-to-understand terms. Why would anyone who is not a doctor even care what Medicare reimburses their docs? Let me tell you why you might care.
Doctors all have one of four designated categories within the Medicare system:
1) The doc participates and accepts Medicare assignment. The fee for the service is set by Medicare, the patient makes a co-pay and the doctor bills Medicare and gets the rest of the fee from Medicare.
2) The doctor is “non-participating” –which is a deceptive term, because non-participating docs are within the Medicare system. The fee for the service is set by Medicare and is typically 5% less then the fee for participating docs, but the patient pays the Medicare fee in full to the doctor, the doctor files a claim with Medicare, and Medicare reimburses the patient for a portion of the fee.
3) The doctor has formally opted-out. In this case, Read more »
*This blog post was originally published at Shrink Rap*
September 28th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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I have opposed Medicare’s use of claims data to evaluate the quality of medical care. Quality medical care is the goal that must be achieved. However, no one has described the measurement of quality medical care adequately.
Physicians recognize when other physicians are not performing quality medical care. Physicians recognize when another physician is just testing and performing procedures to increase revenue.
These over testing physicians are a small minority of physicians in practice.
Quality medical care is not about doing quarterly HbA1c’s on patients with Diabetes Mellitus. Quality medical care is about helping patients control their blood sugars so their HbA1c becomes normalized. It is about the clinical and financial results of treatment.
The clinical and financial results depend on both patients and physicians. Patients must be responsible for Read more »
*This blog post was originally published at Repairing the Healthcare System*
September 22nd, 2011 by Happy Hospitalist in Health Policy, Opinion
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Ask yourself this question: Would you pay 20-30% less in insurance premiums if it meant you were locked into one hospital system for your health care? I would. That’s what one hospital system in Massachusetts is offering to provide. It is, essentially, a concierge hospital plan. You or your employer will pay a set premium, which the hospital is offering at a 20-30% discount, and you get all your health care needs in their system, only going to a competing hospital system if they are unable to provide your necessary services.
What a great idea. In fact, it’s an idea I have thought about previously for Happy’s hospital. Why shouldn’t Happy’s hospital offer direct premiums to large and small business employers in our city in exchange for reduced pricing? I’d sign up. My health insurance premiums cost over $12,000 a year. In the eight years of my practice, I’ve probably sent over $100,000 to health insurance companies and realized less than $10,000 in expenses.
It’s a concept who’s time has come. In fact, direct concierge hospital plans also offer patients and their employers the opportunity for tiered pricing for special amenities (flat screen television service, pet therapy dog service, dialysis spa, designer ostomy covers, wine vending machines, free soda machines, gourmet cookies, closer parking, door-to-door service, and 24 hour special access to their physicians and nursing staff).
No more worries about Read more »
*This blog post was originally published at The Happy Hospitalist*
September 22nd, 2011 by Jessie Gruman, Ph.D. in Health Policy, Opinion
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Every day in the U.S. countless experts discuss plans and policies to contain the cost of health care using words and concepts that run counter to our (the public’s) experiences with finding and using care. Most of us ignore the steady stream of proposals until one political party or the other crafts an inflammatory meme that resonates with our fears of not getting what we need. At which point, we leap into action online, in town meetings and in the voting booth. As Uwe Reinhardt noted in his Kimball Lecture at the recent 2011 ABIM Foundation Forum, researchers and policy makers “cannot even discuss the cost-effectiveness of health care without being called Nazi(s).”
Our discomfort with the array of private and public sector proposals to improve health care quality while holding down costs should not be surprising. Most of us hold long-standing, well-documented beliefs about health care that powerfully influence our responses to such plans. For example, many of us believe that:
… if the doctor ordered it or wants to do it, we must need it.
… talking about less expensive treatments makes us feel that others are trying to bargain-shop our care and that scares us.
… clinical care does not vary much among our own doctors and hospitals.
… when we talk about the “quality” of health care we are referring to Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
