35 Years of Demonstration Projects has Produced What?
Mixed results, apparently:
The project was launched in 2005 after five years of planning. By the end of the third year, all ten groups had achieved fairly high levels of performance — not surprising given the historic emphasis on quality within those organizations. All ten achieved pre-specified benchmarks on 28 of the quality measures, and two of them, Geisinger and Park Nicollet Health Services of St. Louis Park, Minnesota, had surpassed their goals on all 32. But only five groups generated any savings, according to CMS.
Full article on Medicare pilot savings projects.
So what does Congress want to do about it? 35 more years …..35 more years ….. 35 more years.
I can’t really say I am surprised by this result. Is anyone?
We know that Walmart has achieved efficiencies of scale and can move goods to market more efficiently than other large firms. Thus, we know Walmart’s model works. But that doesn’t mean we can force or transplant the Walmart model on struggling Kmart. Competition has to reward efficient providers and punish inefficient providers. The idea that knowledge learned in a demonstration project can be transplanted into other health care systems does not stand to reason.
Remember this is the main(only?)way ObamaCare plans to control Meicare costs — other than squeezing providers and rationing care.
If this is from the 2008 GAO report, quality was measured by HEDIS measures. Did you get a foot exam if you are diabetic? Did you get beta blockers? Does your hemoglobin A1c meet norms?
Access to specialists, inappropriately denied hospitalization, or time spend waiting were not measured. They are important questions when dealing with large integrated practices that can make money by denying care.
Initial startup expenses for each of the 10 practices averaged $489,354. Year one operating expenses averaged $1,265,897. Total start-up and year one operating expenses for the program were $17 million.
Bonuses paid for savings in year 1 totaled $6.4 million. Footnote 20 says that the theoretical savings amounted to $8 million. Based on the description of how bonusthis, it is unlikely that savings exceed the $17 million first year operating costs.
And the NHS would probably do well on these quality measures, too.