September 1st, 2011 by DavidHarlow in Health Policy, News
No Comments »
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*
August 23rd, 2011 by DavidHarlow in Health Policy, News
No Comments »
Partners Health Care (the dominant provider network in Greater Boston) and Neighborhood Health Plan (a local mostly-Medicaid HMO) just announced that the former intends to acquire the latter, and maintain it as a separate operating entity. No money will change hands between the parties, but an unspecified amount of money will be given by Partners as grants to community health centers where NHP members receive much of their health care services. Gary Gottlieb, CEO of Partners, graciously allowed that it would not seek to interfere with the current referral patterns of NHP members to the two local safety-net hospitals (which get disproportionate share hospital payments; Partners hospitals do not).
The deal is contingent on several layers of regulatory review, including Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
July 30th, 2011 by DavidHarlow in Health Policy, Opinion
No Comments »
The UnitedHealth Center for Health Reform and Modernization released a white paper today on Modernizing Rural Health Care. To quote from the UHG presser,
- [The paper] projects an increase of around 5 million newly insured rural residents by 2019 – even as the number of physicians in rural America lags
- Quality of care is rated lower in rural areas in 7 out of every 10 health care markets; both physicians and consumers in rural areas more likely to rate quality of care lower than those in urban and suburban markets
- Innovations in care delivery – particularly telemedicine and telehealth – can absorb future strain on rural health care systems
The paper inventories the current state of health care for the 50 million Americans living in a rural setting — and it’s not pretty. The question, of course, is why does rural health compare unfavorably to urban health metrics, and what can be done to improve matters? Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
July 13th, 2011 by DavidHarlow in Health Policy, Opinion
No Comments »
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 11th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
2 Comments »
I spent the entire last weekend with an attorney, not a desirable circumstance for most physicians. However, I wasn’t being deposed or interrogated on cross examination. This was a rendezvous that we both sought with enthusiasm.
Lewis is my closest friend, a bond that was forged since we were eight years old. We are separated now only by geography, and we meet periodically because we both treasure the friendship. Earlier this year we rolled the dice in Vegas. Last weekend, we sweated in the sweltering heat of the Mile High City. Next stop? Back to Denver with a few youngins’!
Lewis is the managing partner in a prominent west coast law firm that specializes in tax evasion. (Or is it tax avoidance? Am I confusing my terms here, Lew?) He has been redrafted to this position because he has earned the respect of his colleagues. Clearly, both Lewis and I have ascended to the highest strata of our professions. Lewis is in charge of a large law firm that has global reach; he travels all over the world cultivating business and negotiating deals; and he navigates clients through complex and labyrinthine legal conundrums. I, an esteemed community gastroenterologist, perform daily rectal examinations and counsel patients on flatulence.
I am sure that readers will agree that our future professional prestige is already evident in this photo of us taken several decades ago. Read more »
*This blog post was originally published at MD Whistleblower*
