wahoo
3481
Health care bill “model” ACOs say they won’t participate in PPACA’s ACO plan right now. I’m stunned that government bureaucracy can’t get it right.
http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2011/May/May-9-2011/Model-ACO-Health-Centers-Skeptical.aspx
Big story in health policy circles as the model providers are becoming less friendly to the bill.
Umm, why? There’s far more to plastic surgery than just the cosmetic stuff and a whole lot more to dermatology than zit removal. Both provide beneficial services to society.
Umm, because we have a shortage of the ones, and not so much the others, why else?
Organizations covered by CMS regulations are bitching about CMS regulations? Shocking! Other breaking news: Water Wet! Pope Catholic!
You forgot one: Rich people whiny and entitled!
In all seriousness (and wahoo’s posting history doesn’t really deserve the joke response I gave) these types of comments are pretty normal when CMS starts drafting rules and submitting them for comment. The subset of the healtcare industry I worked in at the time had a lot of knashing of teeth and rending of hair when CMS finally proposed new rules to regulate it; the old rules having been tossed out by a judge as arbitrary and capricious. It took awhile, and a lot of propose (Here’s Rule A)-comment(OMG YOU TARDS WANT TO DO WHAT THIS IS BULLSHIT)-edit(Damn, that’s not being received well, lets change 2 things out of a whole document)-propose again(Here’s Rule A Revised) cycles, but everyone worked though them for the most part.
Great chart but one thing really confuses me. It says our outpatient costs are too high, and it compares the UK hospitalization for a hernia with outpatient in the US. But isn’t outpatient cheaper? Surely putting people in the hospital for all the procedures currently done on an outpatient basis is going to cause costs to skyrocket. What am I not understanding here?
Outpatient often hides inferior service behind the appearance of lower costs.
Perhaps but that’s not the argument being made in the charts. So I’m still confused :(
There’s an option you haven’t considered. Making healthcare a right would relegate doctors to slaves who could be conscripted.
maxle
3492
Would his head explode if someone told him he has the right to a trial by jury?
And that pesky right to assistance by counsel. I’m a lawyer, and apparently also A SLAVE!
Unfortunately, the jury part kind of supports his assertion - we’re all required to do it, and while some employers offer jury pay, as far as I know the government isn’t obligated to compensate you for your time. It’s still quite a stretch to get from there to cops breaking down your door in the middle of the night to wrest you into a jury box.
What cracks me up is his citing of the “founding documents” as somehow protecting against slavery, when they actually enshrined it. And also calling out “pursuit of happiness” as proof that no guarantee is given of physical health, ignoring the whole “life” part of that promise. By his reasoning, if I’m dying and you’re a doctor who could save my life? SLAVE!
wahoo
3495
I know some of this is posturing. But the groups are saying no are the very groups that the model ACO is based on. This isn’t like banks screaming about financial regulation.
The history of the ACO in PPACA is looking at Mayo and the Geissinger clinic model and saying that’s what health reform should look like. That we’ll get the savings if we integrate all forms of health services. So the rules are drawn up as a way to entice more companies to act like Mayo/Geissinger.
So right now it’s a big problem that the model companies are saying the rules to create organizations to look like them suck so bad the model companies won’t participate. I’d guess we see some pretty strong revision of the ACO rules but I’m a bit skeptical than the technocrats will get it right.
BTW, Rick Foster Medicare’s chief actuary spoke at AEI on the new Medicare numbers and why he thinks the productivity cuts in ACA won’t last and why there is doublecounting of Medicare savings in the CBO score (the latter in a question from Dave Weigel of slate).
jeffd
3496
Kevin Outterson re ACO’s.
He summarizes:
-CMS announced the new “Pioneer ACO” model for “mature” provider organizations. No rules out yet, just the promise that the rules will be vastly simplified for groups that are already integrated. And they are in a hurry – the letter of intent to participate is due June 10, 2011.
- The second walkback is even more amazing – paying other provider groups to create ACOs. This “Advance Payment ACO Initiative” will pay ACO bonuses in advance. I’m stunned. Pay-for-future-performance.
I’m reasonably sure that most of it is posturing and jockeying with CMS to get the rules they way the providers want; they’re time consuming and somewhat difficult to change after implemented. The thing that most worries me is that (per your earlier link) the rules are supposed to be in place by 1/1/12, and I don’t see that happening.
wahoo
3498
Brandon/Jeff: Mostly similar take and not too surprisign that at least Jeff and I read some of the same blogs.
Outterson’s summary of it: “This isn’t a walkback, it’s a runback” I think illustrates how fast Berwick et al have reacted to this.
And Brandon from what I can tell, they want some of the rules up in the next few months to allow some groups expedited entry into it. I think the ACO concept is great as evidenced by some of the groups. I think ACOs can hold down costs but I’m a bit skeptical that the govt will be able to manage them right. I know that in the past when the govt sets bars for performance pay, the bar is set quite low so everyone gets bonuses (not just in the US, it was a problem in the UK/NICE when I last studied that system a few years ago).
Interesting discussion and worth following.
That’s encouraging, because CMS is IME either heel-draggingly slow/extremely deliberative, depending on your viewpoint.
I think ACOs can hold down costs but I’m a bit skeptical that the govt will be able to manage them right. I know that in the past when the govt sets bars for performance pay, the bar is set quite low so everyone gets bonuses (not just in the US, it was a problem in the UK/NICE when I last studied that system a few years ago).
Interesting discussion and worth following.
The devil’s always in the details. While I’ll be interested in the further proposed and final rules, certainly, I’ll be more interested in the post-implementation tweeks and changes that are sure to come about. 'Cause, you know that when some proto ACO gets money for a couple of years, then gets decertified (for whatever reason), they’re gonna sue.
So there was a pretty big upset in New York today, and it looks like the turning point was solidly on the GOP candidate’s support for the Ryan plan on Medicare. I think you’re going to see a long, hard second look at the plan from the rest of the party as 2012 draws closer.
