ACO Experiment Is Failing

[emd123]

President Obama's own healthcare policy architects now admit their own ACO experiment is not working:

"According to Ezekiel Emanuel, MD, and Topher Spiro, accountable care organizations, the much-hoped-for drivers of delivery and payment transformation, aren’t working so well."

http://www.healthcarefinancenews.co...s-better-model-accountable-care-organizations

Also, changing how doctors are payed is not working either:

"But a new study published last week in the Annals of Family Medicine examined how doctors have been making money in this brave new world vs. the status quo, and found pretty negligible differences."

http://www.columbian.com/news/2015/jul/27/shift-in-incentives-not-changing-doctor-pay/

Ultimately, I think this entire scheme to radically change how we are payed, for "quality" as opposed to quantity of work done is inherently flawed, primarily because nobody knows how to effectively, and objectively measure physician performance quality. They naively think they can measure simple end points like patient blood pressures for one doctor or another, or pain scores for one doctor's patients versus another's, death rates/infection-rates, without accounting for variable such as different populations, compliance, complexity of cases one doctor takes on versus another and other factors.

It is doomed to fail, because it's incredibly difficult if not impossible to measure physician practice "quality" like one measures the performance of something concretely measurable like an athlete's point totals or salesman's sales goals. This will make a mockery of our system.

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[pastafan]

President Obama's own healthcare policy architects now admit their own ACO experiment is not working:

"According to Ezekiel Emanuel, MD, and Topher Spiro, accountable care organizations, the much-hoped-for drivers of delivery and payment transformation, aren’t working so well."

http://www.healthcarefinancenews.co...s-better-model-accountable-care-organizations

Also, changing how doctors are payed is not working either:

"But a new study published last week in the Annals of Family Medicine examined how doctors have been making money in this brave new world vs. the status quo, and found pretty negligible differences."

http://www.columbian.com/news/2015/jul/27/shift-in-incentives-not-changing-doctor-pay/

Ultimately, I think this entire scheme to radically change how we are payed, for "quality" as opposed to quantity of work done is inherently flawed, primarily because nobody knows how to effectively, and objectively measure physician quality. They naively think they can measure simple end points like patient blood pressures for one doctor or another or pain scores for one doctors patients versus another's, without accounting for variable such as different populations, compliance, complexity of cases one doctors takes on versus another and others.

It is doomed to fail, because it's incredibly difficult is not impossible to measure physician practice "quality" like one measures the performance of something concretely measurable like an athletes point totals or salesman's sales goals. This will make a mockery of our system.

And this is unexpected or surprising?

 

[emd123]

And this is unexpected or surprising?

Not to me, but I'm sure it is to those who thought they could create a Utopian system that eliminates the profit motive from Medicine, as long as they could get a chance to run the system their way. My personal opinion is that they'll never admit failure but keep creating solutions to problems, that create more problems than solutions, so they can simply dig their heels in further for more of their own problem creating "solutions." This is the beautify of being a bureaucrat, I suppose, that your own failings only justify more opportunities for you to excel by proposing to fix the problems you and your kind created.

 

[jettavr6]

is that they'll never admit failure but keep creating solutions to problems, that create more problems than solutions, so they can simply dig their heels in further for more of their own problem creating "solutions."

Creating solutions makes a lot of money for people. Especially for those who lobby heavily.

 

[Ligament]

Suck it you Comrade Obama worshippers.

 

[Doctodd]

Socialism fails every time.....we all fail together.

 

[drusso]

It was designed to fail. Now, the push will be for a true single-payer system. Achieving this vision will effectively make *ALL* MD/DO's hospital or ACO employed and controlled by the power of the purse string. The lesson is that physicians must **NOT** give up their professional and economic autonomy and go to work "for the man." Selling out for "magic beans" will only come back and bite you later...

This is rhetoric coming from the LEFT in my state.


Hospitals, Ambulatory Surgery Centers, Specialists Drive up Costs
Diane Lund-Muzikant

Commercial insurance companies are making high margins on the business side, while healthcare costs are way out of control, according to Jack Friedman, the former CEO of Providence Health Plan.

Where’s the real money being made? In hospitals, ambulatory surgical centers and by specialists, Friedman told a group of healthcare executives attending a lecture by T. R. Reid sponsored by The Foundation for Medical Excellence. Reducing administrative expenditures to 4-5 percent won’t make a major difference.

“Government programs are being run on the back of providers who have not been given a unit price fee schedule,” he said. “That’s one shortcoming of the Affordable Care Act.”

Insurance companies were told they could no longer do medical underwriting and had to accept everyone at the same rates, while consumers received tax subsidies to help them pay the premiums.

“But providers were told nothing and got full commercial reimbursement in Oregon,” Friedman said. “They got off scot free. If there had been a fee schedule, there would be more competition and more young people would have entered the market.”

Obamacare is better than the status quo, he added. “But, to be brutally honest we need to make healthcare more affordable by reducing costs 30 to 40 percent for services that have been shown to have no clinical value.”

If the healthcare system were to start over again from scratch, the single payer system advocated by Reid might be the best option, he said, pointing to the start of Medicare and Medicaid in 1965 when there was more effective leadership in the Oval Office and less polarization.

“Now we have to say is it moral to spend more than 20 percent of our GDP on healthcare when we’re only spending 4 percent on education?” Friedman asked, suggesting those dollars should be deployed for housing, public welfare and education.

PacificSource and Providence

Friedman told The Lund Report that his retirement had been delayed because of an impending merger between PacificSource Health Plan and Providence, but couldn’t say what led to its downfall earlier this year.

Since his retirement, Michael White, formerly chief financial officer at Providence, has been named interim CEO, and Friedman expects the health system to name a permanent replacement shortly.

White, who had been Providence’s chief financial officer, now has overall responsibility for day-to-day operations and be responsible for claims and customer service, information systems, provider network strategy, Providence Preferred and sales and marketing of the health plan product line.

“In his nearly three years in the CFO role, Michael has brought great insights to the areas of strategic growth and greater financial alignment between the health plan and Providence’s delivery system,” Friedman said earlier. “He also has helped us lower our administrative costs while providing world-class service.”

Friedman pointed to White’s finance experience on the delivery side and Providence Medical Group, which will help the health plan achieve greater levels of performance as an integrated system.

“The timing of my retirement seems right,” Friedman had said. “We're growing our membership again, and the plan's financial position has never been stronger." He added that the plan's ‘young leaders are’ ready to assume more responsibility, and we need to advance them."

Providence broke the 500,000 enrollment mark with its commercial and self-insured plans, had a strong year in 2014, and became one of only 11 plans in the country given a five-star rating by the Centers for Medicare and Medicaid Services.

“It’s all good, and the system is really happy with the plan and its performance,” said Friedman, who’ll remain on the board of Stand for Children, which is devoted to improving public schools and closing the achievement gap and is also doing private consulting work.

Diane can be reached at [email protected].

Jul 29 2015

 

[emd123]

It was designed to fail. Now, the push will be for a true single-payer system.

I've wondered this all along also, but now I wonder if they've created a system so entrenched, with so many stakeholders that it may be even harder to scrap it all for a single payer system. True single payer means private health insurance is outlawed. I wonder if true single payer's ship has permanently sailed. Is shuttering all the very wealthy and intensely lobbying insurance companies feasible at this point?

 

[hyperalgesia]

I've wondered this all along also, but now I wonder if they've created a system so entrenched, with so many stakeholders that it may be even harder to scrap it all for a single payer system. True single payer means private health insurance is outlawed. I wonder if true single payer's ship has permanently sailed. Is shuttering all the very wealthy and intensely lobbying insurance companies feasible at this point?

They won't be shuttered. The govt will absorb them by making them contractors. Once govt has a COMPLETE monopoly on the entire industry it will put into overdrive the shifting of resources to the insatiable bureaucracy. Finally, an uneasy equilibrium will be reached with worse-than-Medicaid health care access for all. Doctors will be very scarce in this system with bureaucrats and specially trained MA-lite front line people triaging the sickest pts to RNs. As quality continues to decline, the market will grow for cash only, quality medical care. I kind of wish this would happen already, getting nickel and dimed to death sucks.

 

[Mad Jack]

I've wondered this all along also, but now I wonder if they've created a system so entrenched, with so many stakeholders that it may be even harder to scrap it all for a single payer system. True single payer means private health insurance is outlawed. I wonder if true single payer's ship has permanently sailed. Is shuttering all the very wealthy and intensely lobbying insurance companies feasible at this point?

True single payer is a rare thing. In most European countries, you either have basic coverage with the option of purchasing additional private insurance (British-type model, also utilized by Canada and many other non-European countries) or are required to purchase private health insurance (German-type model). True single payer with no option of additional private coverage and no opportunity for providers to opt to only take private coverage is downright communist, and never going to happen here if it can't even happen in some of the most socialist countries in the world.

 

[Stim4me]

Single payer system failed right here in Vermont, USA... They also consolidated all their commercial payers as well thanks to Howard dean... A miserable failure that the news networks continue to neglect...

By the way good old Z. Emmanuel wants everybody dead by 78.... And No No to yearly health care visits, too costly... What an embarrassment for UPENN alumni....

 

[lonelobo]

Single payer system failed right here in Vermont, USA... They also consolidated all their commercial payers as well thanks to Howard dean... A miserable failure that the news networks continue to neglect...

By the way good old Z. Emmanuel wants everybody dead by 78.... And No No to yearly health care visits, too costly... What an embarrassment for UPENN alumni....

I am for 75, Logans Run style- solve the Growing Health care crisis over night

 

[hyperalgesia]

I am for 75, Logans Run style- solve the Growing Health care crisis over night

I recently read about an experiment done with budding yeast. With a variety of methods, the authors were able to significantly extend the lifespan of yeast. But when these genetically "enhanced" colonies competed with wild-type colonies, where maternal cells die of old age, the enhanced colonies were at a significant disadvantage. The wild type colonies were able to outcompete them.

The take home I got from that was that we should hoard resources and be prepared to fight off the other colony.

 

[clubdeac]

We have a single payor system and the media has reported on it's track record....