tag:blogger.com,1999:blog-32053362.post1130503887040092305..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Mr. President, Mr. Governor, please explainPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-32053362.post-378205854937293672009-06-11T08:43:54.534-04:002009-06-11T08:43:54.534-04:00One major incentive for physicians to organize int...One major incentive for physicians to organize into a large group such as an ACO would be a large reduction in malpractice payments and risk. This would also lead to a reduction in defensive medicine, which, despite all the nay-sayers, does contribute to increased health care costs.<br />On another forum, some commenters purported to show that defensive medicine does not exist since physician costs in states with tort reform laws are not different than those without. They don't get it - it's the act of BEING SUED that the physician fears, not how much the plantiff can recover. On recredentialing forms one must report any lawsuit, whether won, lost or settled - to say nothing of all the studies documenting the extreme psychological stress involved, and subsequent practice changes toward even more defensive medicine.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-29859271940537081802009-06-10T22:56:23.939-04:002009-06-10T22:56:23.939-04:00Paul, are there several definitions of Accountable...Paul, are there several definitions of Accountable Care Organizations that you are aware of? You seem to use it in one context referring to a capitated rate of payment to a restricted system of providers.<br /><br />Yet, the Mayo Clinic and Geisinger Health Centers, for example, also seem to go by the nomenclature ACO. My knowledge of these systems is limited, but I thought their cost savings were mostly through reducing the incentive to overutilize services as well as an intense focus on improving efficiency and quality via huge down-payments made in their systems. Is capitation part of their payment structure as well?<br /><br />I agree that there are many limitations to the model, including that there is no incentive for a hospital or group of physicians to take in increased financial risk when any cost savings (under fee for service) just goes back to the insurance company. Also, the financial down-payments needed to make this work are considerable obstacles to smaller groups or rural areas. But in a general sense, how then did places lake the Mayo Clinic or Geisinger make it work, and is this generalizable?Peter Smulowitznoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-62050176724651492862009-06-10T22:47:05.795-04:002009-06-10T22:47:05.795-04:00Perhaps these types of plans should be piloted in ...Perhaps these types of plans should be piloted in "the hills", no, not Beverly. Beacon and Capitol. <br />Let the pols that come up with these ideas provide the litmus test using their families and staffs as subjects.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-23974265021716830042009-06-10T13:07:46.233-04:002009-06-10T13:07:46.233-04:00Paul
You are assuming that regions/areas that have...Paul<br />You are assuming that regions/areas that have the practioner substrate (rural areas off the menu) will "contemplate." I sense a carrot and stick approach, meaning, "you have 5 years to form an ACO" or face ratcheted rates or no bonuses.<br /><br />Not a bad thing, we need to evolve to this model, but my take is CMS will provide the incentives, like it or not, to proceed in this direction.<br />BradAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-68401230971653620872009-06-10T10:21:28.479-04:002009-06-10T10:21:28.479-04:00I was wondering about accountability. My question...I was wondering about accountability. My question has been "accountable to who? and to what standards?". I hoped that the patient and medical ethics would be a part of the answer. It looks like these fundamental questions are not being addressed, and so far I have not seen the patient or medical ethics mentioned.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-35768924682959515602009-06-10T09:11:49.037-04:002009-06-10T09:11:49.037-04:00This whole ACO concept, as I infer from the remark...This whole ACO concept, as I infer from the remark by Mr. Levy (quote below), is a bit scary. <br /><br />"What would make it attractive to tell people that their choices of service providers will be limited to those contained in a given ACO?" <br /><br />Most health care needs can be met by "local level" providers, but there are some conditions for which the best or most appropriate care is avallable only at major medical centers. How would a patient in North Dakota or Alaska have access to the same quality of treatment for cardiac or cancer care that would be available to someone who happened to live near a group of major medical providers such as are available in Boston? Or would the residents of the Dakotas and Alaska have access only the services, skills, treatments, and experience available within the limited boundaries of an ACO within which they reside?<br /><br />If there is to be some kind of management of health care access then access to the best available care when it is appropriate should be assured to all. That could be implemented by identifying regional "Centers of Excellence" in various specialty ares to which members of smaller ACOs would have access, by right, for treatment of appropriate conditions. Those medical centers could be paid a set fee for the services provided if they are serving patients not included in their region.<br /><br />A reasonable standard is that all citizens will have access to the same level of care that is available to members of Congress.Engineer on Medicarenoreply@blogger.com