July 13th, 2011 by DavidHarlow in Health Policy, Opinion
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I spoke with Harvard Business School professor Regina Herzlinger this week about health reform – the good, the bad and the ugly – touching on ACOs and demonstration projects under the Affordable Care Act; innovations coming down the pike in the private sector either because of the law or because of market forces; social media in health care; and two key fixes to the ACA that she believes are absolutely necessary in order to make it work, or work as best it can.
First of all, she expressed her delight at the passage of a federal law nudging us ever closer to universal coverage, combined with dismay at its failure to address rising costs (noting that we’re looking at policies yielding an accumulated Medicare deficit of $90 trillion, as compared to an annual GDP of $12-14 trillion) and at the paltry fines to be leveled at noncompliant employers that do not offer health insurance as required. As rational actors, she expects that more and more employers will simply opt out of the health care insurance market one way or another: Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
July 12th, 2011 by BobDoherty in Health Policy, Opinion
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Watching the negotiations over the debt ceiling legislation is like watching an impending train wreck.
You see a train hurtling down the track, you see an unobservant trucker about to cross, you know that the train engineer and the truck driver have only a few moments to avert disaster, you try to yell and scream to get them to pay attention before disaster strikes—but you have this sinking feeling that your voice won’t be heard until it is too late.
Well, that is how I feel watching the collapsing negotiations over raising the debt ceiling. Responsible persons in both political parties know that a failure by Congress to authorize an increase in the debt ceiling will create incalculable harm to our country, even though some politicians seem to think that default would be no big deal.
But it would be a big deal, and here is why. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
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The sooner President Obama’s Healthcare Reform Act (Obamacare) is repealed the faster we will be able to get on with healthcare reform that will work for all stakeholders.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*
