tag:blogger.com,1999:blog-32053362.post1751758549119059220..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Transparency and "dial tone" to fight market powerPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-32053362.post-49538453108391366362010-11-24T05:47:05.152-05:002010-11-24T05:47:05.152-05:00Excellent column on this subject in the Washington...Excellent column on this subject in the Washington Post; "Health care's dilemma: Competition or Collaboration?"<br /><br />http://www.washingtonpost.com/wp-dyn/content/article/2010/11/23/AR2010112306194.html<br /><br />Interesting idea to exclude health systems already having achieved market dominance from any temporary or permanent anti trust exemptions.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-23462025513557301442010-11-22T14:25:45.524-05:002010-11-22T14:25:45.524-05:00Fortuitously, Dr. Kent Bottles just addressed the ...Fortuitously, Dr. Kent Bottles just addressed the issue of culture and the success of ACO's on his blog:<br /><br />http://kentbottles.blogspot.com/2010/11/hospitals-need-to-focus-on-culture-in.html<br /><br />One can make all the rules we want, but until we all internalize the culture of caring for patients instead of making money, not much will change.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-18092897077403680452010-11-22T08:20:29.489-05:002010-11-22T08:20:29.489-05:00I agree with the general thrust of your comments, ...I agree with the general thrust of your comments, but I think the proposals qualify as "necessary but not sufficient". The very idea of a medical home, I believe, is that patients will remain with a single ACO based on the affiliation of their primary care provider - thus exercise of 'consumer choice' would be limited anyway, yes?<br /> <br />And, at least in Boston, it's clear that subscribers really don't care if the rates are transparent because they think their hospital deserves these rates due to (perceived) high quality of care - a view shared by at least one local hospital administrator.<br /><br />Therefore we come full circle back to the payment mechanism, which is really at the heart of the problem. If one organization can negotiate higher global payments for the same care, as you suggest, then the entire idea of global payments is subverted, since they would have no incentive to become efficient.<br /><br /> I hate to say it, but I think the idea of competition in health care has already been shown not to work, and efforts to encourage it will only be overcome by gaming the rules. I would love for you economists to tell me why I am wrong, but I am not hopeful.<br /><br />We need some drastically new ideas.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-37903394622527018432010-11-21T22:54:16.374-05:002010-11-21T22:54:16.374-05:00I agree it will be interesting to see how this all...I agree it will be interesting to see how this all plays out being economic times are complicating issues. We have some hospitals in California that basically become Cadillac ER rooms once bought by Prime Healthcare, who is known for buying up financially strapped hospitals and sometimes is their only choice. Prime as I understand is just now beginning to sign contracts but resists so they can charge their customary fees. Basically everything that does not drive a profit gets cut and the money avenue of course is the ER room so they are first class operations. How ACOs will work here is kind of question I think. They are not the busy centers they used to be and you can roll bowling balls in the parking lot today, as a couple of them are in my area and I drive by all the time. <br /><br />http://ducknetweb.blogspot.com/2010/11/prime-healthcare-buys-alvarado-hospital.html<br /><br />We also have 2 new non profit organizations set up to help small chain and independent hospitals with their work with ACOs. This came on the heels of the City of Hope judgment where the current physician's group was to be abandoned and all MDs are now required to join the new group created by the hospital or face no longer being on staff. The Hope situation was kind of ugly with both the hospital and physician's group filing suit against each other before the ruling came out.<br /><br />This situation also set a precedence here and I guess we will see who's next up to bat with their ACOs and how physician's groups fair. During the time before the judgment was given, there were MDs worried and it could be that they will have less representation. In California we have laws which prohibit doctors from being direct employees of a hospital so they all have physician groups. <br /><br />http://ducknetweb.blogspot.com/2010/11/hospital-associations-in-california-set.html<br /><br />Hoag Hospital in Newport Beach, which is in a good position for funding almost any time simply due to where they are and the community donations that flow in, also lead the first ACO Congress meeting held in Century City a few weeks ago.Medical Quackhttps://www.blogger.com/profile/12443589277651479846noreply@blogger.com