April 20th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
No Comments »
In 2009 President Obama stated that Accountable Care Organizations (ACOs) were going to be pilot programs in real world settings. The goal was to see if they effective in reducing costs and increasing “quality of care.” The results of the pilot programs have not been published.
Last week despite the lack of proof of concept HHS and CMS announced new proposed regulations for ACOs.
The new delivery and payment model the agency estimates could serve up to 5 million Medicare beneficiaries through participating providers, and also potentially save the Medicare program as much as $960 million over three years.
How were these estimates derived? It could be another accounting trick by President Obama’s administration.
The idea of coordinating care and developing systems of care is a great idea theoretically. From a practical standpoint, execution is very difficult.
I tried to execute something similar in 1996 with the American Association of Clinical Endocrinologists; a national Independent Practice Association. AACECare received little cooperation or interest from Clinical Endocrinologists.
The problem is coordinated medical care is dependent on physicians cooperating and not competing with each other. It also depends on hospital systems developing an equitable partnership with physicians.
The equitable partnerships between hospital systems and physicians are difficult to achieve if past results are any indication of future results. Read more »
*This blog post was originally published at Repairing the Healthcare System*
April 10th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
No Comments »
President Obama’s has created an incentive program to encourage physicians to adopt functional Electronic Medical Records. The program’s $27 billion dollars (funded by President Obama’s Economic Stimulus package) will turn out to be a colossal failure and a waste of money.
Twenty seven billion dollars would provide $44,000 for 640,000 physicians. After the bureaucratic infrastructure is built the federal government will be lucky if one third of the money remains for bonuses to physicians.
Only 21,000 of 650,000 (3%) of physicians have applied to date.
Complex bureaucracies and complicated regulations never save money. These bureaucracies create bigger government, inconsistent policies, more complicated regulations and inefficiencies.
The best and cheapest way to create a universally accepted and functional EMR is for the federal government to put the software in the cloud and charge physicians by the click for the use of the Ideal Medical Record.
Upgrades in software to the Ideal Medical Record will be swift , inexpensive and instantly adopted. Read more »
*This blog post was originally published at Repairing the Healthcare System*
April 1st, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
No Comments »
The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process.
1. The decision making process can become opaque rather than transparent.
2. Decisions are made by a committee by consensus.
3. Consensus committee decisions might not sharply define the original goals.
4. Blame for errors gets dissipated.
5. Decisions are only as good as the information that is gathered.
6. Changing a wrong decision can be difficult and costly.
President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations.
The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care of Type 2 Diabetes Mellitus 15 or 20 years. It is a decision being made using the wrong information. Read more »
*This blog post was originally published at Repairing the Healthcare System*
March 20th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
No Comments »
Last year’s “Doctor Fix” was passed the last week congress was in session in 2010. This was after the medical profession was held in suspense for 9 months.
The “Doctor Fix” was supposedly the result of President Obama making a deal with the AMA for the AMA’s support. He was going to pass a real “Doctor Fix” in 2011 by repairing the defective sustainable growth rate formula (SGR). Nothing has been done about this by President Obama in 2011. The cumulative physician reimbursement reduction of 25% was suspended until January 2012.
Physicians face a 29.5% Medicare Pay Cut in January 2012. Four and one half percent was added to last year’s cumulative physicians reimbursement reduction. The reduction was calculated into the CBO’s cost score for President Obama’s Healthcare Reform Act.
Last week an official with the Centers for Medicare and Medicaid Services unveiled the 29.5% rate reduction for 2012 in a recent letter to the Medicare Payment Advisory Commission. This will become another distraction for physicians and the media as President Obama stalls for time. Read more »
*This blog post was originally published at Repairing the Healthcare System*
November 22nd, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, News, Research
No Comments »
What is the Federal Coordinating Council for Comparative Effectiveness Research?
The mission of the Federal Coordinating Council for Comparative Effectiveness Research will be to decide on best practices and most cost effective practices. The council will recommend cost effective treatments for diseases to the National Coordinator for Health Information Technology (NCFHIT). The NCFHIT will determine treatment at the time and place of care. It is charged with deciding the course of treatment for the diagnosis given by the doctor.
The U.S. Department of Health and Human Services (HHS) announced the formation and membership of the Federal Coordinating Council for Comparative Effectiveness Research that will be funded by President Obama’s stimulus program the American Recovery and Reinvestment Act (ARRA). The council was allocated $1.1 billion to set up comparative effectiveness of medical practice.
Why was this $1.1 billion funded from the economic stimulus package?
Unknown. The missions are based on the premise that practicing physicians do not have the ability to recommend the most cost-effective medical treatment for their patients. (See executive summary.)
Who are the members?
The members of the committee were picked without congressional approval immediately after the economic stimulus bill was passed. They are all bureaucrats working for the government in one capacity or another. There are no practicing physicians on the panel.
*This blog post was originally published at Repairing the Healthcare System*
