'Accountable Care' Organ. design/template are hummmm................not quite so good

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Trajan, Jun 20, 2011.

  1. Trajan

    Trajan conscientia mille testes

    Jun 17, 2010
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    The Bay Area Soviet
    *shrugs* my worry is they may never hot on the right formula and due to budget and date/timing benchmarks, by pass 'real-world, real people' beta testing there by applying the inevitable shoehorning before the 2012 election, they will jam the proverbial 5 lb. bologna into the 3 lb sack and just make things worse, by rolling n out an ignorant plan.


    ( PLEASE read the article as it is continued at the link)

    * JUNE 19, 2011, 7:21 P.M. ET

    The Accountable Care Fiasco
    Even the models for health reform hate the new HHS rule.

    The Obama Administration is handing out waivers far and wide for its health-care bill, but behind the scenes the bureaucracy is grinding ahead writing new regulations. The latest example is the rule for Accountable Care Organizations that are supposed to be the crown jewel of cost-saving reform. One problem: The draft rule is so awful that even the models for it say they won't participate.

    The theory for ACOs, as they're known, is that hospitals, primary-care doctors and specialists will work more efficiently in teams, like at the Mayo Clinic and other top U.S. hospitals. ACOs are meant to fix health care's too-many-cooks predicament. The average senior on Medicare sees two physicians and five specialists, 13 on average for those with chronic illnesses. Most likely, those doctors aren't coordinating patient care.

    This fragmentation is largely an artifact of Medicare's price control regime: The classic case study is Duke University Hospital, which cut the costs of treating congestive heart failure by 40% but then dumped the integration program because it lost money under Medicare's fee schedule.

    Intelligent liberals now concede this reality but claim that the government merely needs to devise better price controls. By changing the way it pays, Medicare under the ACO rule is effectively mandating a new business model for practicing medicine. The vague cost-control hope is that ACOs will run pilot programs like Duke's and the successful ones will become best practices. While the program is voluntary for now, the government's intention is to make it mandatory in the coming years.

    But what if they had an ACO revolution and no one showed up? The American Medical Group Association, a trade association of multispeciality practice groups and other integrated providers, calls the rule recently drafted by the Department of Health and Human Services "overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve." In a survey of its members, 93% said they won't enroll.

    The Administration wrote its rule based on an ACO pilot program that started in 2005 among 10 high-performing physician groups, including Geisinger Health System and Dartmouth-Hitchcock. All 10 say they have "serious reservations" about the new rule and that without major revisions "we will be unable to participate." In other words, the providers that are already closest to being an ACO have rejected the Administration's handiwork.

    And no wonder, since the 429-page rule is a classic of top-down micromanagement. ACOs will need to comply with a kitchen sink of 65 clinical measures that are meant to produce efficiencies, like reducing infections or ensuring that patients take their medications after hospital discharge. If care at an ACO costs less than Medicare predicts it will cost under the status quo, then the ACO will receive a share of the savings as a bonus payment. The rule also includes financial penalties if an ACO misses its targets.

    Incredibly, the ACO teams won't know in advance which patients they're supposed to manage. Seniors will be "retrospectively assigned" to an ACO at the end of every year, based on an arbitrary algorithm, for the purposes of calculating costs.

    Think about that one: The Geisinger model works because Geisinger patients are treated by Geisinger physicians. Yet this rule is written to ensure that seniors can take "advantage of the full range of benefits to which they are entitled under the Medicare FFS program, including the right to choose between healthcare providers and care settings." So ACOs are going to transform health care, but individual patients don't need to be part of the transformation if they don't feel like it.

    Oh, and HHS reserves the right to conduct site visits and audits and "to inspect all books, contracts, records, documents, and other evidence" to ensure that health systems are complying with the ACO rule. The mystery is why even 7% say they'll participate.

    more at-

    Review & Outlook: The Accountable Care Fiasco - WSJ.com


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