A Midsummer Wonk’s Dream

Welcome to the Midsummer Health Wonk Review!  It’s always a pleasure to host, and this edition actually isn’t a Shakespeare theme, but it is jam-packed with excellent articles from some of the best writers in the healthcare blog world.  The HWR had a break before this edition and will have a hiatus after this one too. We’re starting things off with a few articles that help to shed light on some aspects of health care reform that should be straight-forward but sometimes get a bit convoluted with political rhetoric.  Then we’ve got several posts about corruption in healthcare and healthcare policy, and lots of posts that provide contrasting and well-reasoned viewpoints on healthcare reform and healthcare in general.  We’ll keep things cool with some winter and spring pictures we took around us here in Northern Colorado.  Enjoy!

Colorado mountains near Fort CollinsIn an excellent piece debunking popular “wisdom” regarding immigrants and healthcare, Joe Paduda of Managed Care Matters explains that when it comes to the Medicare Trust Fund, immigrants put in a lot more than they take out:  In 2009, immigrants paid in 14.7% of trust fund contributions but only accounted for 7.9% of its spending, with a net surplus of almost $14 billion.  US-born people accounted for a deficit of almost $31 billion in the Medicare Trust Fund that same year.  This appears to be a long-term trend:  From 2002 to 2009, immigrants contributed $115.2 billion more to the Medicare Trust Fund than they received in Medicare benefits.  Joe goes on to explain the details and warn those who rally behind strict immigration reform that they may want to rethink their position.  Our Medicare Trust Fund would be in a lot worse shape without the immigrant population.

And if you’re curious about the implementation track for the ACA (and understandably confused by the constant talk of repeal, delay, replace, etc. that we keep hearing from some politicians) Linda Bergthold has what I consider to be a straight-forward and factual review of the situation.  To sum it up, she’s predicting that the employer mandate will go into effect in 2015, as currently scheduled (following a one-year delay, but not a repeal), and that the individual mandate will be implemented in 2014, as planned.  And while some states that delayed the creation of an exchange marketplace will likely have a tougher time getting everything up and running by 2014, the exchanges will be operational next year.  I imagine there will be some bumps in the road as the ACA is fully implemented over the next few years.  But we can work on ironing those out as we go – there’s no need to start from scratch.

Although the exchanges are likely to be successful in the long run, it won’t be without significant effort on the part of the people running them.  At Health Affairs Blog, Barbara Markham Smith and Jack Meyer explain their recommendations for strategies that can help the exchanges be successful both out of the gates and for the long haul.  They discuss pricing (don’t make it too high!) as well as communication/advertising programs that need to be unified, clear, concise and nation-wide in order to generate awareness and interest in as many people as possible.  Baby pine tree in snow(Unfortunately, there’s a significant portion of the country’s leadership who seem to want the exchanges to fail – even to the detriment of the American people – and are content to spread mis-information about the entire law.  This is a considerable hurdle that the exchanges will have to overcome.)  Barbara and Jack recommend a temporary respite from the tax reconciliation that will be done to determine whether a person or family that received a subsidy is required to pay back a portion of it due to increased income compared with the prior year.  And they also call for fostering increased competition and CO-OP creation in the states have not yet done so.  All in all, pretty solid ideas for success in the exchanges and policy-makers would be wise to take heed.

I think of Dr. Roy Poses as the healthcare blog world whistleblower – he can always be counted on to expose nefarious acts in the healthcare industry, and Health Care Renewal is a must-read blog.  Here is his take on the recent Transparency International poll that found 43% of US respondents believe that the US healthcare system is corrupt, and that 64% believe that the government is run by big money and special interests.  Roy notes that unfortunately, most of the media coverage of the Transparency International poll has focused on world-wide data and/or specifics from far-away lands.  Instead of focusing on our own serious problems with corruption in healthcare, it seems that a lot of media outlets (keep in mind that media is sometimes beholden to special interests too…) prefer to present the problem as something that happens in other countries as opposed to something that we need to work on here in the US.

Continuing with the corruption theme, Eric Turkewitz of the NY Personal Injury Law Blog shares a multi-part series about Dr. Katz, who has been rebuked for lying on the stand in a personal injury trial that resulted in a mistrial because of the doctor’s actions.  Central to the issue is the practice of independent medical exams (with the word “independent” being very loosely used in this case) conducted by doctors who are hired by insurance companies when they are defending personal injury cases.  In the case that Eric is writing about, the doctor makes a 7 figure income creek in Fort Collins Coloradofrom his medical-legal practice, but in one case that has been made public, he grossly over-stated the amount of time he spent with a patient (he claimed it was 10 – 20 minutes, but a secretly-made video recording of the visit showed that it was under two minutes).  Eric has looked at additional data and found that the average length of Dr. Katz’s exams was around 4 minutes.  Additional details on this story are here.  Wow.  The doctor was obviously concerned first and foremost with money, but the insurance companies who hired him were likely not doing due diligence to make sure that he was providing accurate data.  They may have been more concerned with finding a doctor who would tell them what they wanted to hear rather than the actual details of the patients’ medical cases.  Sad all around, but sadder still is the fact that it’s probably not all that unusual.

And for a little more on the cronyism/corruption topic (maybe those corruption figures Roy mentioned from the Transparency International poll were skewed a bit too low?), Hank Stern of InsureBlog writes about agencies and individuals who have been involved with the Obama Administration for some time, and are now finding themselves in lucrative financial and/or influential positions as the ACA gets implemented.  In other words, business as usual in the government.  Government appointments, grants, etc. are often awarded this way (ie, appearing to be rewards for donations and/or loyalty), in every administration, regardless of which party is in power.  There’s ample room for opponents to cry foul, but it also has to be pointed out that presidents and secretaries and others in power have to be able to select people they trust for top leadership positions.  And trust is earned over time.  There’s a fine line between selecting the right candidate for the job, having that person be someone trusted by the top officials, and avoiding cronyism.  I don’t know what the right answer is, but it’s easy to see how the appointments and grants and leadership roles being handed out with the ACA could be construed as rewards for political support and loyalty.

At Health Beat, Maggie Mahar writes a thoughtful and thorough review of Miriam Zoll’s Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies.  After reading Maggie’s article, I’m eager to read the book itself (Maggie leaves a bit of a cliff hanger at the end…).  Assisted reproductive technology is certainly a blessing to many families.  But it can also be fraught with problems that stem from both overly-optimistic expectations on the part of patients (and society in general), over-promising on the part of providers, and a medical field that is largely unregulated and often not covered by health insurance policies.

At Health Business Blog, David Williams explains his skepticism about DealWell, a new Priceline-style website for healthcare services.  I am very much in favor of increasing transparency in healthcare pricing and moving away from the proprietary pricing system we have now, where even the most dedicated patient “shoppers” can find it impossible to obtain real healthcare prices before having a procedure.  And to that end, I love thePut a bird on it! idea of a website where people can bid on the care they need and providers can accept or decline the offer depending on their current workload and the payment offered.  But David makes some excellent points about the downsides:  not being integrated with health insurance is a big one, especially since nearly everyone will have to have health insurance starting in 2014 (even if a procedure is lower than your deductible, it makes sense to stay in network and have the amount you pay be credited towards your deductible, in case you need additional care later in the year).  Although DealWell might be a good option for people looking for one-time services that aren’t covered by health insurance (such a LASIK or a dental implant, for example), it’s probably not going to be the next big thing in healthcare price transparency.

Over at Disease Management Care Blog, Jaan Sidorov takes a closer look at the glowing picture painted by CMS regarding ACO pilot programs, digs a little deeper, and gives us a slightly less rosy view of the results.  And there’s even a T-Rex analogy, to keep things even more interesting.  Jaan points out that the ACOs that didn’t meet the pilot program goals are likely feeling the sting of losing millions of dollars, since the initial investment costs are not cheap.  Although 9 of the 32 pilot ACO providers have said that they want to leave the program, I wonder if results will be better as time goes by, mitigating the initial investment costs somewhat?  Stay tuned.

Julie Ferguson of Workers’ Comp Insider writes about the July 6th 777 crash at SFO, detailing how the flight attendants did an excellent job of putting their emergency training into practice, saving lives in the process.  Julie notes that while it’s easy to shrug off emergency plans simply because we rarely come face-to-face with an emergency, such preparedness can mean the difference between life and death.  Does your business have a solid plan in place to deal with emergencies?  Has everyone at the business been trained on it?  How fast can your building be evacuated if necessary?  All good things to think about.

Writing at Health Access Blog, Anthony Wright discusses the one-year delay of the employer mandate portion of the ACA that will require employers with more than 50 employees to provide health insurance to eligible full-time workers.  Anthony makes some very important points:  the delay doesn’t impact anyone’s eligibility for health insurance and/or subsidies.  People who would have been offered health insurance from an sledding in Coloradoemployer with the employer mandate in place will still be able to get coverage through their state’s exchange – and if they make up to 400% of the federal poverty level, they’ll qualify for subsidies to help pay for it.  In addition, the vast majority of large employers in the US already offer health insurance to their employees and have historically done so without a mandate requiring it.  It’s unlikely that a large amount of those employers will suddenly drop their coverage in 2014.  But Anthony goes on to note that if the delay were extended for additional years, it could begin to destabilize the financial foundation of the ACA and employers might begin to shift more workers onto exchange plans, relying on tax-funded subsidies to foot a portion of the bill.

The Healthcare Economist, aka Jason Shafrin, brings us a great summary of health insurance in China over the past half century.  Until the end of the 1970s, there were three main health insurance systems in China that covered nearly everyone.  But the wheels started to come off after that; by 1998 almost half of the urban population had no health insurance, and by 2003, 95% of the rural population in China was uninsured.  In the last ten years, China has tackled health care reform in order to try to remedy the problem.  While plenty of progress has been made, there is still a long way to go.

Jared Rhoads has written a review of The Autistic Brain by Temple Grandin.  His review is a good read, and the book looks like it is as well.  Professor Grandin teaches at Colorado State University – my alma mater –  and consults for the livestock industry as well as being a bestselling author.   She’s an inspiring and accomplished person even without taking into account her own autism.  Her book combines her personal Temple Grandin professor at CSU - Colorado State Universityexperiences with the latest that science has to offer us with regards to autism.  If you’re interested in autism, Jared’s summary is that this book is a good place to start learning more.  I’m adding it to my list of books to read, so thanks for the tip Jared!

John Goodman lays out some of the results of the ACA thus far (fair enough, but keep in mind that most of the law hasn’t been implemented yet).  He details some positives and negatives, both expected and unintended, although his overall take is that the ACA is not a great solution.  Strongly worded opinions about the ACA will likely meet with a round of applause from one side of the political spectrum, and boos from the other side.  But regardless of your position, I would say that it’s tough to argue with John’s point about high deductible, consumer-driven health plans.  I think he’s correct in saying that they’re probably going to be quite popular starting in 2014, when they will be among the least-expensive plans available.  This is probably particularly true among people who won’t qualify for subsidies.

That’s it for this mid-summer edition of the Health Wonk Review.  Many thanks to Julie and Joe for keeping such a great blog carnival going all these years!  The HWR now has a summer hiatus. Don’t miss the next edition on August 15th, which will be hosted by David Williams at Health Business Blog.

Playoff Health Wonk Review, And The Other Side Of The ACO Coin

An excellent baseball-playoff themed edition of the Health Wonk Review is at Wing of Zock, hosted by Jennifer Salopek – be sure to head over and check it out. This article by Jason Shafrin should be of interest to anyone who has been paying attention to all the talk about ACOs lately. I have been generally impressed with what I’ve read regarding the potential cost savings and improved efficiency that ACOs will hopefully provide. However, although health care reform has focused quite a bit of energy on the creation of ACOs, it is far […]

Primary Care Practices In Colorado Chosen As Part Of CMS Pilot Program

The Centers for Medicare & Medicaid Services (CMS) announced this week the start of a pilot program to enhance primary care via collaboration among CMS, private health insurance carriers and 500 primary care practices in seven regions across the US. 73 of those practices are in Colorado, with 335 participating physicians, and several of the top health insurance carriers in Colorado are participating too: Anthem Blue Cross Blue Shield, Cigna, Humana, Rocky Mountain Health Plans, and United Healthcare, in addition to Colorado Medicaid, Colorado Choice Health Plans, and Colorado Access (a health plan specifically designed for underserved populations).

CMS will be paying participating providers a “care management fee” which is estimated to be about $20 per month per beneficiary, in addition to the usual fee-for-service reimbursements. The private health insurance carriers that are participating have worked out their own reimbursement schedules, but one would assume that the setup will be similar to the one that CMS has devised. […]

SCOTUS Lead-Up Health Wonk Review, And The Free Market Nature Of The ACA

[…] Under the ACA, most health insurance carriers, hospitals, medical offices, pharmaceutical companies, device makers, etc. will all remain privately operated, in the free market. It’s true that the ACA establishes some guidelines that the private entities – and individuals – must follow. Individual health insurance will be guaranteed issue by law, and everyone will be required to purchase health insurance (assuming that the individual mandate isn’t overturned by the Supreme Court), with subsidies helping many families cover the cost. But the products that will be purchased – health insurance and healthcare – will still be primarily in the private sector. I think Justin makes some very good points, especially at the end of his article when he talks about the future. The ACA is by no means perfect, and I believe it will need plenty of tweaks over the years, even if it’s upheld in its entirety by the court. But if it’s overturned and we wait several more years to implement a replacement, we might find that it ends up being a far less free-market-friendly approach.

ACO Downsides

Attorney Nina Kallen hosted this week’s Cavalcade of Risk, and it included a couple of interesting entries about the Facebook IPO. Given that we write about health insurance, I especially liked Dr. Jaan Sidorov’s article comparing Facebook and ACOs. His verdict? Well, you’ll have to read his article to get the details, but he’s not particularly impressed with either one. I tend to see ACOs in a relatively positive light, and I think they have a lot of potential for cost savings and creating more of a teamwork dynamic between providers and health insurance carriers. But Dr. Sidorov makes some good points about the potential downsides. As usual, good food for thought from the Disease Management Care Blog.

A Shared-Risk Success Story

[…] In addition to beating their target financially, the program has also resulted in happier patients, increased market share for Blue Shield, fewer patient readmissions (likely due to the comprehensive patient discharge program that they created, and better chronic care management), a significant decrease in the number of inpatient days per thousand members, and far lower start-up administration costs than are typically projected for ACOs (although they note that they worked with existing programs and already-established relationships, so they weren’t building an ACO from scratch. But I imagine that would likely be the case with most ACO creation?). […]

Too Big To Fail?

[…] Given the large market share that some hospital systems and health insurance carriers have in other states, I wonder if those organizations might already be “too big to fail”, even before ACOs come into the picture? Would the financial collapse of one of those systems be too much of a destabilizing factor and require a government bailout in order to protect the communities served by the healthcare organizations?

So far, we haven’t seen such a scenario. In general, when a healthcare organization leaves the market, it is bought out by another organization that is more financially sound (for example, Celtic agreed to take over World and American Republic’s insureds last year when those companies left the market). This happens quite often with hospitals and small-ish health insurance carriers. But the titans of the financial industry that had to be bailed out in 2008 were not the “small-ish” banks – they were huge organizations that everyone thought were very sound. If something like that were to happen to healthcare organizations – either insurers or large hospital systems – would a bailout be necessary in order to stabilize the healthcare system?

I assume that ACOs are being crafted with a bit more care and transparency than what went into CDOs. And hopefully the lessons learned in the financial markets crisis will be well-remembered as healthcare market overhauls are created.

Replicating Grand Junction’s Healthcare System

[…] This is a scenario that I could see being implemented even without a monopoly by one health insurance carrier. Grand Junction aside, if we look at the whole state of Colorado, the top 70% of the health insurance market is comprised of ten carriers. I wonder if it would be possible for medical offices to set up agreements whereby they pool money received from those ten carriers and from Medicare, Medicaid, and CHP+. Then instead of paying physicians directly from the health insurer depending on the insurance coverage of each specific patient, the doctors could simply be paid either a salary or an average reimbursement for each patient, regardless of which insurance that patient had. This would require some restructuring in terms of how medical billing is done, but it would allow medical offices to continue to negotiate competitive contracts with private health insurers (and the higher the contracted rate, the more total dollars the medical practice would have to put into their payment pool).

One of the major factors that contributes to the success of the system in Grand Junction is that doctors there are ok with receiving lower total incomes than they would in other areas that don’t function the way Grand Junction does. When you pool Medicare and Medicaid payments together with private health insurance payments, the public health insurance reimbursements drag down the average payment. In order to make sure that people with public health insurance are receiving equal access to healthcare (which they currently do not, especially those with Medicaid), the per-patient average reimbursement for physicians would have to decrease, since it would mean that more lower-paying patients would be treated. The caveat that doctors would have to be willing to work for a little less money is especially true of specialists, which is where the highest incomes are. […]

Cavalcade Of Risk And Shared Savings Programs For Small Physician Groups

Dr. Jaan Sirorov of the Disease Management Care Blog hosts this week’s Cavalcade of Risk, and it’s an excellent edition.  Be sure to check out Jaan’s own article in the Cavalcade, discussing the practicality of small (four doctors) primary care practices entering into collaborative savings arrangements with health insurers. I recently wrote about how Cigna […]

A Doctor Who Cooks Brussels Sprouts For A Patient

[…] Dr. Flansbaum’s article is a must-read if you’re interested in the socioeconomic factors that contribute to obesity and “lifestyle” health conditions. Colorado has the distinction of being the least-obese state in the US (although we recently passed the 20% mark in terms of the percentage of adults who are obese). I’m sure this is due in large part to the state’s relatively affluent population, the plethora of outdoor activities available (combined with 300 days of sunshine each year), and the plentiful food choices available. Of course there’s a bit of a chicken-or-the-egg question too… are there plenty of healthful food choices available here because the people who live here demand them, or are there healthy people here because of all the good food options we have?

Cigna And CSHP Collaborating On An Accountable Care Program

[…] The collaboration between Cigna and CSHP will focus on improving patient outcomes, making healthcare more accessible and affordable, and improving patient satisfaction. One of the key components of the Cigna program is registered nurses working at the medical offices who will serve as care coordinators. These care coordinators will follow up with recently hospitalized patients to try to avoid preventable re-hospitalizations (costly and definitely not likely to result in a satisfied patient). They will also work with patients who have chronic illnesses to make sure the patients are filling their prescriptions, receiving needed office visits and screenings, and getting referrals to disease management programs that could help to prevent the conditions from worsening. The hands-on approach that the medical offices will be taking is likely to result in fewer re-hospitalizations and better overall compliance with medical advice.

Hopefully the program will also provide guidance for patients who aren’t filling prescriptions because they cannot afford to do so (for example, a referral to pharmaceutical company programs that provide free medications to people who can’t afford them), and help to address issues like lack of transportation or inability to fit medical office visits into inflexible work schedules. Some people truly just need a reminder to go get a screening test or refill a prescription. Others have more significant obstacles preventing them from doing so. […]

Will Healthcare IT Lead To Lower Healthcare Costs?

[…] My guess is that increased HIT will eventually (after the hiccups and bugs are worked out) result in more efficient care, better coordination of care between multiple doctors, fewer medical errors, and more streamlined health insurance claim processing. After reading the articles by McCormick et al and Mostashari, I think it’s clear that there’s some controversy in terms of whether HIT will lead to lower costs. I do think that HIT is coming one way or the other. It’s 2012. Most Americans are walking around with a touch screen mini computer in their pockets. We expect lightening fast internet connections and instant access to virtually any data we can think of. HIT will have to keep up, simply because technology keeps improving and it has to follow suit. But we’d be wise to carefully consider empirical data as much as possible in order to implement systems that have the best chance of success in terms of improving care and also lowering costs.

Too Much Paperwork

[…] I don’t know what the solution is here. On the one hand, we need regulation. We know that without it, there are way too many cracks into which all sorts of things can fall. And regulation is meaningless without having a way to objectively measure compliance and progress. But when we reach the point where doctors feel that they’re spending more of their time doing clerical work (eg, filling out compliance paperwork, documenting everything for their lawyers and for their patients’ health insurance carriers, etc.) than interacting with patients, perhaps it’s time to re-evaluate.

This is especially important as the ACA rolls out over the next few years. One of the goals is to make healthcare more efficient. But if we inadvertently end up bogging down the healthcare professionals in a sea of red tape and bureaucracy, efficiency is likely to decline. Hopefully doctors and nurses and other healthcare professionals – who work in the healthcare field on a daily basis – can be consulted to provide input on how best to measure compliance with well-intentioned regulatory programs.

New T.R. Reid Documentary Highlights Greatness In Our Healthcare System

[…] Overutilization – driven by supply rather than demand – was another common theme in the program. Basically, that the more healthcare supply we have (eg, scanning machines), the more utilization we have. This accounts for a large part of the huge variation in healthcare costs from one city to another. And in all of the hospitals and medical practices featured on the program, curbing over-utilization has been a high priority. One hospital figured out that blood transfusions during surgery aren’t nearly as necessary as they once thought (and indeed, the patients often do better without them). Given that the total cost of blood transfusions is about $1000/pint (!), that’s quite a cost-saving discovery. In another large clinic, pharmaceutical reps were no longer allowed to visit and they also removed the samples of brand name drugs that once filled their drawers. This was a controversial move, but they analyzed a lot of data provided by their local Blue Cross insurance carrier and found that they could optimize pharmaceutical care for a lot less money – patients had better outcomes and the clinic reduced overall Rx spending by $88/million a year compared with the state average.

The Program also showed and example of how patient-centered medical homes work in the real world. PCMHs are a huge buzz word these days, but the PBS documentary shows one in action, and they did a great job of making it easy for patients to visualize how such a program would work and how it would benefit us – including things like much more face time with doctors, and a reduction in the number of hospitalizations and ER visits. In addition to PCMHs, shared decision making between doctors and patients (another buzz word in healthcare reform) was highlighted as having a positive impact on both utilization and patient satisfaction. […]

Consumer-Driven Healthcare Debate

[…]prior to reading Ungar’s article I wasn’t aware of the agreement between the Independent Physicians Association and Rocky Mountain Health Plans with regard to Medicare and Medicaid reimbursement. The doctors in the IPA were so determined to treat every patient equally that they worked out an arrangement with RMHP to have the insurance carrier accept payment directly from Medicare and Medicaid and then pool that money together with premiums collected from RMHP insureds.
[…] Hixon argues that patients with more financial responsibility for their own care do indeed make better decisions regarding efficient use of healthcare dollars. Furthermore, he cites a study that found that patients with high deductible health insurance policies (eg, HSA qualified plans) had more preventive care, lower rates of hospitalization, and were more compliant in terms of following their doctors’ recommendations. They were also more likely to question their medical bills and had overall lower medical costs than people with traditional low-deductible policies.

[…] In addition to probably being above average in terms of financial savvy, I would assume that the demographic that opts for high deductible health insurance is also probably healthier than average. It makes sense that the more health problems a person has, the more likely he’ll be to choose a lower-deductible policy, since he knows he’s likely to be using the policy at least somewhat regularly. On the other hand, a person with no health conditions at all is probably making a good gamble to select a high deductible policy, since there’s a decent chance he’ll be able to go for several years without having a major claim. So the fact that people with HDHPs have lower medical costs isn’t really surprising. It’s largely a self-selected group (employers who offer an HDHP usually offer another plan as well, and everyone shopping for individual health insurance who picks an HDHP has other options from which to choose). I’m not sure that medical costs would still be lower for people with HDHPs if they policy designs were assigned randomly across the entire population.

Combining Patient Satisfaction With Clinical Outcomes And Cost Efficiency

[…] Particularly in the current era of spiraling healthcare costs, it’s a bit troubling to hear that hospitals are doing things like putting in extra elevators so that people don’t have to wait as long for an elevator… all for the sake of boosting their patient satisfaction rankings. Yes, it might increase patient satisfaction by a small margin, but somebody has to pay for it. Renovation projects like that add to the hospital’s overhead expenses, and that leads to increased charges for care at the hospital. Ultimately, health insurance carriers end up paying more for their insureds’ claims, and that translates directly to increased health insurance premiums […]

Real-Time Tracking Of Healthcare Costs

[…] Obviously we have to avoid cutting corners just for the sake of lowering costs at the expense of patient outcomes (again, including patient outcomes when we compare the cost data would help to prevent this problem). But I have no doubt that there are other healthcare expenses that could be eliminated without compromising patient outcomes. In many cases, the providers might just be unaware of the actual costs that are being incurred – Dr. Fogelson’s idea for a real-time digital tracker would help to keep cost in the front of everyone’s mind.

A Good Trend In Medicare Spending

[…] She specifically addresses Medicare costs, but it stands to reason that the same cost-saving strategies and paradigm shifts will also help to lower healthcare costs that are being reimbursed by private health insurance carriers. Not only do private carriers tend to follow Medicare’s lead, but the focus on value over volume from a provider perspective will benefit everyone, as it’s unlikely to be applied only to Medicare patients.

ACOs in the Health Wonk News

my favorites had to do with accountable care organizations (ACOs). Much like health insurance exchanges, ACOs are a bit of a buzz word these days, but are often misunderstood. Of course things like that tend to lend themselves well to consulting gigs, and Paul Hsieh of Pajamas Media points out that the initial phases of development and implementation of ACOs has already created a consulting niche that is raking in huge amounts of money from hospitals and doctors who want to figure out the best way to design their ACOs. $25,000 a day for […]

PVHS and UCH Begin Process Of Creating A Joint Hospital System

[…] The merger is expected to provide numerous benefits for both hospital systems, and will presumably make for lower total operating/administrative costs than they would have if they weren’t working together. As health care costs continue to climb, this should help both hospitals continue to provide quality care to their patients. It’s also reasonable to assume that the merger will be beneficial for UCH and PVHS patients, since access to both hospital system’s strengths will likely be available to patients in both Denver and Northern Colorado. […]

Surprising Effect Of More PCPs On Healthcare Costs

[…] The Dartmouth study results might seem counter-intuitive, since we often assume that as long as people are getting regular care by a PCP, they will be more able to avoid expensive hospitalizations. That appears to be true, but the lower cost office visits and outpatient treatments add up faster than one might expect, and would actually exceed the cost of the hospitalizations that they would prevent. […]

Potential ACO Models

[…] The article delves into the Medicare savings that the government is hoping to realize as a result of ACOs, and also discusses several potential ACO models that are currently in use by various health plans around the country. If you’re curious about how ACOs might work, the ACP Internist article is a good primer.

Interesting Data Regarding Pay For Performance Studies

[…] There has been much debate recently about what is the most efficient and cost-effective method of reimbursing doctors and hospitals. While most providers now are paid on a fee-for-service model, there’s concern that such a model tends to encourage over-utilization. ACOs might pose a possible solution, although their designers would be wise to ponder the data regarding pay-for-performance, since much of the success of ACOs could hinge on providers’ ability to “perform” in terms of keeping their patients healthy and avoiding costly hospitalizations.

Consumer Protections And The PPACA

I doubt that regulators will simply throw out the existing rules and allow ACOs to operate without consumer protections to place to guard against fraud and abuse. Instead, I see them coming up with new regulations that take into account the changing landscape of health care delivery, including ACOs. But either way, the creation of new consumer protections while suspending others does make for an interesting discussion. […]

ACOs 101

Accountable Care Organizations (ACOs) have received a lot of buzz lately as the nation grapples with ways to reign in health care costs. But I think that there’s still a lot of confusion about how they would work. A couple of very informative posts on the topic were included in this week’s Grand Rounds, and I wanted to share them with our readers. […]