August 2nd, 2011 by Toni Brayer, M.D. in Health Policy, Opinion
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Close your eyes and think of a doctor. Do you see a Marcus Welby type? A middle-aged, smiling and friendly gentleman who makes house calls? Is his cozy office staffed by a long time nurse and receptionist who knows you well and handles everything for you? If that is what you envision, either you haven’t been to the doctor lately or you are in a concierge practice where you pay a large upfront fee for this type of practice. Whether you live in a big city or a rural community, small practices are dissolving as fast as Alka Selzer. Hospitals and health systems are recruiting the physicians, buying their assets (unfortunately not worth much) and running the offices.
Doctors are leaving small practices and going into the protection of larger groups and corporations because of economic changes that have made it harder and harder for small practices to survive. The need for computer systems, increasing regulations, insurance consolidation, skyrocketing overhead and salaries coupled with low reimbursement has signaled the extinction of the Marcus Welby practice. Some older doctors are finishing out their years and will shutter their offices when they retire. Young to middle age physicians are selling out to large groups and new physicians would never even consider this type of practice. They are looking for an employed model from the outset.
Every doctor I know who is currently in private practice is Read more »
*This blog post was originally published at ACP Internist*
June 18th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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The sooner President Obama’s Healthcare Reform Act (Obamacare) is repealed the faster we will be able to get on with healthcare reform that will work for all stakeholders. President Obama figured that 30 existing and successful integrated medical care organizations would be in the first group of clinics to join and be included in his Accountable Care Organization (ACO) system of care.
ACOs are a critical part of Obamacare’s goal to provide affordable, universal and quality healthcare. ACOs are really HMO’s on steroids. ACOs are supposed to be better versions of HMO’s. The public and physicians despised HMO’s because of its control over patient choice and access to care. President Obama thinks Medicare will save over $500 billion dollars a year with ACOs. Unfortunately for President Obama, neither the CBO nor the Medicare actuaries believe it.
So far at least 4 of President Obama’s premier integrated healthcare organizations have Read more »
*This blog post was originally published at Repairing the Healthcare System*
June 14th, 2011 by DavidHarlow in Health Policy, Opinion
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There has been a significant outcry against the proposed ACO regs: everything’s wrong and nothing’s right about them, or so some would have us believe. (The comment period is still open, and CMS is still soliciting input; much of the outcry is a form of posturing and negotiation … not that there’s anything wrong with that.)
Today’s “nattering nabobs of negativism” focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure incuded), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, the premature pledging of allegiance to an idea only partly proven through the PGP demo, the likelihood of failure due to the whole endeavor’s being tied to FFS reimbursement, on the one hand, and due to exposure of ACOs to downside risk, on the other, the unreasonable reliance on dozens and dozens of quality measures . . . and the list goes on. For further detail, see, e.g., David Dranove’s recent post decrying unproven theories baked into the ACO program (with a link to info on the PGP demo’s results, and differing interpretations of those results; check out the lively discussion in the comments to Dranove’s post on The Health Care Blog), Jeff Goldsmith’s opposition to ACOs as conceived in the ACA (and alternative proposal discussed in the linked post), and Mark Browne’s search for a few good quality measures. (This has been a recurring theme for me as well; I would love to find six or eight meta-measures that predict all others; Mark links to the AHA’s comments on the ACO rule, which are worth a read). Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
May 11th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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In an ideal world ACOs should work. There is no evidence that untested and complex organizational structure of ACOs developed by Dr. Don Berwick (head of CMS) will improve quality of care and reduce costs.
ACOs are supposed to provide financial incentives to health care organizations to reduce costs and improve quality. There are too many defects in the ACOs infrastructure to improve the financial and medical outcomes.
At a conceptual level, the incentive for ACOs would be to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members would share the savings resulting from the increased coordination of care.
I have said over and over again that excessive administrative fees and ineffective management of chronic disease is the main source of waste in the healthcare system. ACOs do not deal with these main drivers of costs.
The only stakeholders who can demand that this waste be eliminated are consumers/patients. Patients must control their healthcare dollars. They will make sure there are competitive prices and will not permit duplication of services. Read more »
*This blog post was originally published at Repairing the Healthcare System*
May 3rd, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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Thousands of articles have been written about forming ACOs. Millions of dollars have been spent by hospital systems to try to form an ACO. Healthcare policy consultants have discovered a new cash cow.
Hospitals systems are wasting their money. They think the return from owning salaried physicians’ intellectual property will be more than worth the cost.
- Thousands of physicians have been confused by the concept of ACO.
- Many have felt ACOs are an attack on their freedom to practice medicine the best they can.
- Many have rejected the concept because they feel they will have to be salaried by hospital systems.
- Many physicians do not trust President Obama or Dr. Don Berwick.
- The Stage 2 ACO regulations are not easy to understand. They are more ominous than the stage 1 regulations.
The two core stated objectives for ACOs are:
(1) Reducing healthcare costs.
(2) Preserving and improving quality.
The stated objectives are laudable. The government regulations and controls are confusing. Read more »
*This blog post was originally published at Repairing the Healthcare System*
