The Accountable Care Fiasco (Even the models for health reform hate the new HHS rule)

WSJ ^ | 6/19/11

[markomalley]

The Obama Administration is handing out waivers far and wide for its health-care bill, but behind the scenes the bureaucracy is grinding ahead writing new regulations. The latest example is the rule for Accountable Care Organizations that are supposed to be the crown jewel of cost-saving reform. One problem: The draft rule is so awful that even the models for it say they won't participate. ***

The theory for ACOs, as they're known, is that hospitals, primary-care doctors and specialists will work more efficiently in teams, like at the Mayo Clinic and other top U.S. hospitals. ACOs are meant to fix health care's too-many-cooks predicament. The average senior on Medicare sees two physicians and five specialists, 13 on average for those with chronic illnesses. Most likely, those doctors aren't coordinating patient care.

This fragmentation is largely an artifact of Medicare's price control regime: The classic case study is Duke University Hospital, which cut the costs of treating congestive heart failure by 40% but then dumped the integration program because it lost money under Medicare's fee schedule.

(snip)

But what if they had an ACO revolution and no one showed up? The American Medical Group Association, a trade association of multispeciality practice groups and other integrated providers, calls the rule recently drafted by the Department of Health and Human Services "overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve." In a survey of its members, 93% said they won't enroll.

The Administration wrote its rule based on an ACO pilot program that started in 2005 among 10 high-performing physician groups, including Geisinger Health System and Dartmouth-Hitchcock. All 10 say they have "serious reservations" about the new rule and that without major revisions "we will be unable to participate."

[GlockThe Vote]

The total collapse is one step closer.

FFFUUUBBBOOOO

[rarestia]

Our hospital group is trying to go ACO, and it’s been an absolute IT nightmare. I’ll be interested to see how this comes out in the wash.

[sickoflibs]

RE :"The theory for ACOs, as they're known, is that hospitals, primary-care doctors and specialists will work more efficiently in teams, like at the Mayo Clinic and other top U.S. hospitals. ACOs are meant to fix health care's too-many-cooks predicament. The average senior on Medicare sees two physicians and five specialists, 13 on average for those with chronic illnesses. Most likely, those doctors aren't coordinating patient care. This fragmentation is largely an artifact of Medicare's price control regime: The classic case study is Duke University Hospital, which cut the costs of treating congestive heart failure by 40% but then dumped the integration program because it lost money under Medicare's fee schedule. "

Obama-care medicare ping!

[Liz]

Casino owner Steve Wynn did a TV spot----blasting Obama as a rookie (Wynn voted for Obama).

Wynn pays heathcare costs for thousands of his employees---a big percentage of his operating costs. Said the costs jumped alarmingly------from 8% to 12%------the OPPOSITE of what Obama told the nation. Wynn was furious.

[sickoflibs]

RE :” Casino owner Steve Wynn did a TV spot——blasting Obama as a rookie (Wynn voted for Obama). Wynn pays heathcare costs for thousands of his employees-—a big percentage of his operating costs. Said the costs jumped alarmingly———from 8% to 12%———the OPPOSITE of what Obama told the nation. Wynn was furious.”

Early 2009 many small business owners supported Obama’s promises on Obama-care because they were getting killed by increasing insurance costs. Obama not only promised those large risk pools but competition and government subsities and promised them lower cost insurance to make them more cometitive, exact words.

These small business owners must not have paided attention in 1993 and 1994 exactly 16 years earlier because one of the things that sunk the Hillary-care ship was the endless political demands for endless mandated minimum benefits seen by congress as ‘free-bees’. A great example is the mandate for free chest x-rays that only benefit women but cannot be directly added to their premiums and must be cost spread to men who cant used them.

On one hand Obama used free-loaders using emergency rooms as a rational for the personal mandate (there is an attractive argument for this in a limited sense), on the other hand the bill gets loaded up with all kinds of special interest political crap that ‘mandated/forced’ customers dont need under the label of prevention.

Example : I had a liberal (in 2010) tell me Obama-care should be extended to illegals to save money because they cost so much in emergency rooms, this was the Democrat argument. I easily refuted it pointing out that illegals do not get million dollar cancer treatments in emergency rooms nor access to his personal doctor unless he works in one.

[Condor51]

I haven't seen or heard about Wynn blasting Barry on his costs going up, but I thought that was a foregone conclusion that anyone who was listening knew.

But his part of the article is really ironic..

The theory for ACOs, as they're known, is that hospitals, primary-care doctors and specialists will work more efficiently in teams, like at the Mayo Clinic and other top U.S. hospitals. ACOs are meant to fix health care's too-many-cooks predicament..

I didn't know it before but now I find I've been part of one of these 'ACOs' for decades. It started small, originally just our GP and a couple specialists (Like Orthopedic & Neurology) who started a 'Clinic' and were all working at our closest Hospital. As I went to each Dr my complete file was already there when I showed up. That was pretty convenient and cut the paperwork.

Now it's a huge 'Medical Group' that covers everything from Family Practice to Oncology -- and my original file is still there and precedes me to whatever Dr I'd ever have to see. Of course now my file about two inches think ;-) And the Drs are all Certified Staff with that same Hospital we all started with. And my file goes there too when I had to have a procedure done.

So these ACOs do work when done right. And 'my' Doctors and Hospital did this all on their own. No gubmint interference required.

[Liz]

YOU GET A PRIZE IF YOU CAN FIND Accountable Care Organizations in this diagram.

Here it is----your new Obamacare healthcare system. O/Care adds over 100 new boards, commissions and programs. For example a new Medicare Commission, exempt from judicial review, will unilaterally write rules about utilization and pricing of medical devices and drugs often needed by surgeons. Many regulatory bodies will be overarching in their abilities to select and direct medical subjects concerning Tri-Care, employer group policies, Veteran’s Administration, Medicare, Medicaid, etc.

Diligent govt personnel could not fit all of O'Care's new law’s boards, commissions, mandates, and other elements on this chart. So they created “bundles of bureaucracy.”

Seven collective symbols respectively represent clusters of four loan repayment and forgiveness programs, four other new regulatory programs, 17 insurance mandates, 19 special-interest provisions, 22 other new bureaucracies, 26 other new demonstration and pilot programs, and 59 other new grant programs.....

NOTE These 151 additions do not appear individually on the Obamacare diagram. If included, the diagram would be three times larger.

[stephenjohnbanker]

” RE :” Casino owner Steve Wynn did a TV spot——blasting Obama as a rookie (Wynn voted for Obama)”

Uh....Wynn did NOT vote for Obama, his wife did.

[Condor51]

*** YOU GET A PRIZE IF YOU CAN FIND Accountable Care Organizations in this diagram. ***

Not fair. That's a trick question ;-)

That diagram isn't about 'Care' or being 'Accountable'.
It's about GUBMINT POWER (but we FReepers know that).

[Liz]

Wynn did NOT vote for Obama, his wife did.

Mmmmm.......which wife? His wife of 30 years that he divorced recently? Or the new one he just married?

BTW, I actually saw the Wynn interview. The moderator mentioned Wynn voted for Obama during the interview---Wynn did not deny it.

[Marine_Uncle]

“Hillary-care ship”. I remember those days quite well.

[mo]

the idea..of course is..is that we all be fodder for some great bureaucratic machine that will provide lifetime tenure to a bunch of Ivy League egg-head administrators....rather than generating a health-care system to the service of the patient and the doctor.

[mo]

“... will work more efficiently in teams, like at the Mayo Clinic and other top U.S. hospitals. “

Snort!!Snort!!

the Mayo Clinic has REFUSED to get involved with this mess

http://www.fiercehealthcare.com/story/mayo-forgoes-aco-rejects-participation/2011-06-13

You think a real reporter...rather than a propagandist with an agenda..would have figured that out...

[SunkenCiv]

Thanks sickoflibs.

[stephenjohnbanker]

” Mmmmm.......which wife? His wife of 30 years that he divorced recently? Or the new one he just married?

BTW, I actually saw the Wynn interview. The moderator mentioned Wynn voted for Obama during the interview-—Wynn did not deny it. “

Something is indeed VERY weird! I watched Wynn state that he did NOT vote for Obama. Oh well....

[Liz]

Not to beg the question-——but Steve Wynn also told Cavuto he voted for Obama, but has had a “change of heart”. He used the most scathing language about Obama heard to date.

http://www.youtube.com/watch?v=Ml-xOt16jCY

[stephenjohnbanker]

You win! Wynn, that is ;-)