September 1st, 2011 by DavidHarlow in Health Policy, News
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Many health care provider organizations have not been overly eager to jump onto the Accountable Care Organization (ACO) bandwagon, citing high startup costs and uncertain returns on investment given the complexity of the program. Well, recently, the CMS Center for Innovation has announced the Bundled Payment for Care Improvement initiative. This initiative incorporates elements of earlier CMS demonstration projects — the gainsharing demos and ACE (acute care episode) bundled payments demonstrations which the HealthBlawger has helped a number of clients around the country qualify for in the past — and builds on the broad authority granted to the CMS Center for Innovation under health reform.
The advantages to proceeding with a Bundled Payment for Care Improvement project include the opportunity to participate in CMS shared savings programs while only providing limited commitment of organizational resources, i.e., limited to one or more discrete service lines or episodes of care. Of course, investments in a culture of collaboration must be made, but the system-wide investment in IT and other infrastructure at the level called for in order to qualify as an ACO would not necessarily be required in order to proceed with this initiative.
There are a number of different models open to participants, and nonbinding letters of commitment are due as early as late September.
From the CMS Center for Innovation announcement: Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
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The sooner President Obama’s Healthcare Reform Act (Obamacare) is repealed the faster we will be able to get on with healthcare reform that will work for all stakeholders.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*
June 13th, 2011 by BobDoherty in Health Policy
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This question has to be asked, because health policy gurus are looking to the new Center for Medicare and Medicaid Innovation (“the Innovation Center”), created by the Affordable Care Act, as being the principal driver of innovative delivery system reforms to “bend the cost curve”— but skeptics wonder if it can live up to its billing.
The Innovation Center’s website says all of the right things:
“The Innovation Center has the resources and flexibility to rapidly test innovative care and payment models and encourage widespread adoption of practices that deliver better health care at lower cost.
Our Mission: better care and better health at reduced costs through improvement. The Center will accomplish these goals by being a constructive and trustworthy partner in identifying, testing, and spreading new models of care and payment. We seek to provide: Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
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*
