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Large Contract Management Groups (CMG) have exploded, and now dominate most contracts. Teamhealth, EmCare, CEP, EMP control most of the large hospital contracts in the country.
I think their days are numbered, and with good reason.
Accountable Care Organizations (ACOs) are coming. ACOs will be made up of insurers, hospital systems and physician groups. These are in response to the new bundled payment structure coming from CMS. Under this new payment plan fee-for-service will go away, and payment will be made for an "episode of care" and include "quality measures". That means the surgeon, hospital, internist, and ER doctor will have one pool of money from which they all get paid. The reason for all of this is that it's a smoke-and-mirrors method of cutting medical costs without angering the AARP through direct cuts to Medicare.
The reason that CMGs are doomed is that the ER doctor has no place in this new ACO structure. ACOs are not going to pay any more money for a re-admission within 30 days for the same problem. So imagine a CHFer gets sent home too soon and bounces back to the ER. Will we get paid for seeing them? Under an ACO model, we won't as it would technically still be the same "episode of care" and that money has already been spent. CMGs will be dinosaurs, since fee-for-service billing will be a thing of the past, and the hospital, will likely be determining how much is paid out to us. This means that we will probably be transitioned to a Kaiser model, whereby a hospital system directly employs us and pays us hourly. Additionally because of the "quality measures", hospitals will want to keep us on a tight leash so they can minimize the loss of payments for missing quality metrics.
We can already see this happening with large groups like CEP who have aligned themselves with large hospital systems like Dignity Health in anticipation of the ACO formation.
Thoughts?
I think their days are numbered, and with good reason.
Accountable Care Organizations (ACOs) are coming. ACOs will be made up of insurers, hospital systems and physician groups. These are in response to the new bundled payment structure coming from CMS. Under this new payment plan fee-for-service will go away, and payment will be made for an "episode of care" and include "quality measures". That means the surgeon, hospital, internist, and ER doctor will have one pool of money from which they all get paid. The reason for all of this is that it's a smoke-and-mirrors method of cutting medical costs without angering the AARP through direct cuts to Medicare.
The reason that CMGs are doomed is that the ER doctor has no place in this new ACO structure. ACOs are not going to pay any more money for a re-admission within 30 days for the same problem. So imagine a CHFer gets sent home too soon and bounces back to the ER. Will we get paid for seeing them? Under an ACO model, we won't as it would technically still be the same "episode of care" and that money has already been spent. CMGs will be dinosaurs, since fee-for-service billing will be a thing of the past, and the hospital, will likely be determining how much is paid out to us. This means that we will probably be transitioned to a Kaiser model, whereby a hospital system directly employs us and pays us hourly. Additionally because of the "quality measures", hospitals will want to keep us on a tight leash so they can minimize the loss of payments for missing quality metrics.
We can already see this happening with large groups like CEP who have aligned themselves with large hospital systems like Dignity Health in anticipation of the ACO formation.
Thoughts?