Monday, January 10, 2011

Accountability? Heaven forbid!

At a recent talk, Dartmouth's Elliott Fisher facetiously remarked that we cannot yet be sure whether accountable care organizations (ACOs) will actually be accountable, caring, and organized. Well, if some providers have their way, they certainly won't be accountable.

This story by Jordan Rau in the Washington Post relates comments being made as Medicare writes its rules governing the ACOs. Here are some quotes:

[S]ome prominent doctor and hospital groups are pushing for features that some experts say could undermine the overall goal - improving care while containing costs. They're seeking limits on how the quality of their care will be judged, along with bonus rules that would make it easier for them to be paid extra for their work and to be paid quickly.

Here's the one I like best:

The Federation of American Hospitals, representing for-profit facilities, goes further, urging that ACOs be allowed to choose their patients. "Providers are better positioned than CMS to determine which of their patients would be appropriate candidates," the federation wrote.

So, we are happy to be held accountable, but only if we get to choose which patients are part of our network.

And, how about this from the American Medical Association?

The medical association doesn't want surveys of patient experiences to be used in evaluating ACOs.

Right. What do the patients know, anyway?

And from my soon-to-be-former hospital association:

In the dispute over financial incentives, the American Hospital Association is pushing CMS to let providers collect bonuses early on and in full rather than having some of the bonuses deferred as an added incentive to keep up the good work.

Collect bonuses before you earn them? Of course.


e-Patient Dave said...

I expect the associations would assert that these rules are simply fair (right, associations?), so they surely will offer the same to their employees.

To thus paraphrase the Washington Post article: "the American Hospital Association is pushing CMS to let [employees] collect bonuses early on and in full rather than having some of the bonuses deferred as an added incentive to keep up the good work." And "The [employees] don't want [supervisor opinion] to be used in evaluating [them]."

Right, AHA and AMA? Fair?

Look, all I want is for patients to get the care they're paying for, and not be killed in the process. I'm sure all the readers of this blog are aware of the Inspector General's recent report that said 500 Medicare patients a day are accidentally killed (15,000 a month) and >4,000 are harmed. (That wasn't a guess or opinion, it's historical data.)

That being the case, no wonder the associations wouldn't want the government asking patients what THEY thought.

It rather reminds me of when I, at age 4, told Mom I was ready for dessert (by "bonus"), but also told her not to look at my plate.

e-Patient Dave said...

I wish this Blogspot blogging platform would allow editing of comments ... I meant dessert was "my bonus" not "by bonus".

lynnie said...

Dear Paul,
As a patient with deep roots at BIDMC, it has taken my family and I, literally days, to come to terms with your departure. I can barely write the words with out feelings of sadness.
You, the kind, generous and thoughtful human being will be missed and your leadership will be a great loss.
Blessings to you always,

Paul Roemer said...

There are many carts before the horses when it comes to ACOs.

Implementing EHRs at hospitals has already disrupted dysfunctional business models, dropping productivity at some hospitals by 20-30 percent.

Trying to implement ACOs over that same model will make the ACOs seem dysfunctional. For those who are serious about ACOs, one must hope they are equally serious about planning for them.

Anonymous said...

I hope that CMS is able to bring some sanity to an insane situation. The jockeying for advantage and position is nothing more than Washington politics as usual. My concern about ACO's is that no one really knows what they are (hello, Don?) and so all 3 major player categories are sort of throwing something together and pasting a name on it just to qualify for $$. The only advantage I see to the current situation is that it is - in a literal sense - disruptive of the fee for service system. Chaos may reign for awhile, but we cannot go back. And this from someone whose HSA/high deductible plan with 10K deductible just went up another 16.5%. It will get worse before it gets better.

nonlocal MD

Justin K said...

Off topic -- Since this blog will continue, perhaps ask for our help in the renaming. I'm sure you will get some great names, some you might choose not to post, and some light, humorous, and airy.

Even though we are losing you, some of us will still follow you and your travels. So bring us in to lighten the mood, as whatever you post, most comments will be still focused on losing you, and as such, lets have some fun with it. (I mean it with the utmost respect as both changes in general and the situation at hand is definitely not fun)

Jim said...

I have found your blog enlightening and entertaining. I also hope you will remain involved in some way with healthcare. We are better with you than without you.

However, allow me to offer an alternative interpretation of an observation you made today:

"And from my soon-to-be-former hospital association:

"In the dispute over financial incentives, the American Hospital Association is pushing CMS to let providers collect bonuses early on and in full rather than having some of the bonuses deferred as an added incentive to keep up the good work.

"Collect bonuses before you earn them? Of course."

You may be familiar with some of the body of behavioral economics (popularized in books such as Nudge and Predictably Irrational). We as humans value losses differently than gains. As a result, I propose that asking for money back at the end of the year as part of a value-based purchasing plan would have greater impact than awarding it the end of the year. Only downside would be a lack of interest accrued by the federal government in withholding that money for the year (not a small amount assuredly). Perhaps all bonuses should be awarded before and the employee has to pay it back if he/she doesn’t achieve the objectives.

Anonymous said...

Good blog. Nice to see someone is talking about hospital accountablity and transparency issues. Just saw you tube videos titled, "Autistic Adult in Crisis Goes Unnoticed" and "Shocking Neglect of Autistic Patient". Now that's a wake up call