ACO's and the AMC

[kazuma]

---

Members don't see this ad.

CMS has made it quite clear that they plan to eventually move away from fee for service and towards ACO's and alternative payment models including global payments and capitation. Some estimates say that by 2020 CMS plans to eliminate FFS and use these alternative payment models. This more or less removes private groups and AMC's from directly billing for our services.

My question is why are AMC's investing millions into groups that appear to have minimal if any ability to directly bill for their services in the near future? An AMC is a middleman to be paid under an ACO and I don't see why an ACO would use an AMC if a hospital system has the ability to directly employ and control payments to individual providers.

As much as I'd like to think that ACO's are going to disappear, it seems they are here to stay. This is different than the HMO scares of the mid 90's. CMS sees physician payments as an easy target to save money and "balance the budget" even though physician payments only make up ~16% of CMS expenses.

 

[deleted171991]

It's much harder and politically unattractive to do what every successful healthcare system in the world does: cut down on heroic measures in the last year of life. Just the last 6 months of life cost Medicare 28% of its budget. We are admitting patients to the ICUs who have no business of being there, just so that the family can fly in and say goodbye. For $10,000/day.

How do they do it in Europe? They just say NO to heroic measures (including intensive care), if there is very little likelihood of long-term survival.

 

[kazuma]

It's much harder and politically unattractive to do what every successful healthcare system in the world does: cut down on heroic measures in the last year of life. Just the last 6 months of life cost Medicare 28% of its budget. We are admitting patients to the ICUs who have no business of being there, just so that the family can fly in and say goodbye. For $10,000/day.

How do they do it in Europe? They just say NO to heroic measures, if there is very little likelihood of long-term survival.

So true, but it's easier to take money from the "greedy" doctors instead of telling the constituents that grammy is going to hospice instead of the $10k/night 5 star hotel.

 

[dhb]

How do they do it in Europe? They just say NO to heroic measures (including intensive care), if there is very little likelihood of long-term survival.

Not everywhere in Europe, there is stil a ton of futile care

 

[B-Bone]

So true, but it's easier to take money from the "greedy" doctors instead of telling the constituents that grammy is going to hospice instead of the $10k/night 5 star hotel.

To wit, we did a TAVR on a 99 year old a few weeks ago. MONEY WELL SPENT!!!

 

[2ndyear]

CMS has made it quite clear that they plan to eventually move away from fee for service and towards ACO's and alternative payment models including global payments and capitation. Some estimates say that by 2020 CMS plans to eliminate FFS and use these alternative payment models. This more or less removes private groups and AMC's from directly billing for our services.

My question is why are AMC's investing millions into groups that appear to have minimal if any ability to directly bill for their services in the near future? An AMC is a middleman to be paid under an ACO and I don't see why an ACO would use an AMC if a hospital system has the ability to directly employ and control payments to individual providers.

As much as I'd like to think that ACO's are going to disappear, it seems they are here to stay. This is different than the HMO scares of the mid 90's. CMS sees physician payments as an easy target to save money and "balance the budget" even though physician payments only make up ~16% of CMS expenses.

I see 2 reasons why AMC's are still investing lots of cash into anesthesia:
1) Lots of groups have little Medicare/Medicaid patients, if they're 80-90% private insurance you can afford to take a big hit on your Medicare because it doesn't matter as much. Also we're already paid approximately 70% less on average for Medicare, at least in my area. So if this gets cut another 25%, as long as it isn't a large part of your practice then it just doesn't have a huge impact.

2) The AMC's are gearing themselves for a sale. There have already been a few of these, but basically they just churn cash for a few years and get sold to another private equity company. Nobody is thinking about the future, just how much money is there in the short term.

 

[Carbocation1]

http://www.physynergy.com/blog-anes...of-Anesthesia-Services-Reading-The-Tea-Leaves

Anesthesia Reviews Blog
Current Articles| RSS Feed
The Future of Anesthesia Services? Reading The Tea Leaves
Posted byWilliam Hasson Mon, Feb 09, 2015 @ 08:08 AM

Some claim to be able to tell the future by reading tea leaves. I know I can’t, but somewhere out there is someone who thinks they might make sense of seemingly, or even possibly, unimportant stuff. See how you do with these.

What are you supposed to think when the Chief Operating Officer in an anesthesia management company sells his shares in the company? Why? Enough to buy a new car? Only if it’s a Rolls Royce. Does this mean that knowing what he knows there is a better investment available? Could be or it could be something else, but it does seem a bit odd.

Then try this. As I’m sure many anesthesiologists did this week, I received a very nice e-mail from a department chief looking for associates. I have a license in that state and had at times thought of relocating there, so I checked it out. I knew that an AMC had taken over a contract in this town, so I wondered if this was the other hospital. If you are to believe general AMC literature, anesthesia professionals flock to their contracts and perhaps the recruiting hospital had lost significant members of its staff to the “better” AMC deal. With just a little investigation determined that the e-mail recruiting letter was from the AMC's contract hospital. Interesting. The flock was missing.
It was also interesting to see that another AMC has a vacancy in its leadership when it’s CEO left for another healthcare position.

Is this the beginning of the end of this iteration of AMCs? Could be or it could just another week in a busy business world. Try this reasoning and you decide.
Changing the ownership on the title for a Ford doesn’t make it a Ferrari. If you don’t do preventive maintenance on the Ford or try to add some after market parts that just don’t fit right, pretty soon you have a Yugo or a smoking clunker sitting by the side of the road. You would be surprised the stories that experienced anesthesia service management could tell you about bad plans poorly executed. And these stories are not just limited to AMCs. Some anesthesia service consultants and experts (“ACEs”), especially those without extensive leadership experience, can provide “advice” to facilities that dramatically increase costs without a significant increase in financial and operational performance. If your subsidy goes up and services don’t after involvement with an ACE, maybe it’s time for a second opinion.
It comes to this…..Is there a “secret sauce” in anesthesia service management? My answer is yes…..more to follow.



Comments
We just recently had the county hospital which is contracted with an AMC that shares it's name with a city in Wyoming lose it's chief and also it's other respected anesthesiologist for ? reasons.
I think that corporate can squeeze only so much blood out of a turnip before the turnip becomes worthless.
Posted @ Monday, February 09, 2015 8:01 PM by Bob Goethe

 

[BLADEMDA]

This is just like the housing bubble in 2007 or the Nasdaq in January of 2000. That is why the SMART money is selling their practices at record numbers in '14 and '15. The chance to lock in huge profits now before the tide turns in '19 or '20 is just too tempting for those of us who lived through these bubbles.

Unlike many on this Board I know GREED comes before the fall and Wallstreet is greedy. If they want to buy anesthesia contracts which could be worthless circa 2020 then go ahead and sell it to them.

Anyone remember those internet stocks from 1999?

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[deleted682700]

I am happy that this takeover party is soon going to be over. Amsurg took over a surgery center in a near by town. The anesthesiologists were part owners, however surgeons, major share holder gave the contract to am surg. Of course the anesthesiologists who did not get paid salary when they first started, the owners would come and beg the anesthesiologists. They made all kinds of promises. Now 15 years later they kicked out the part owner anesthesiologists and gave it to amsurg. Business world has no loyalty.