Another Way to Ration Care
The Obama Administration doesn’t need a public plan to control costs. It can pressure private plans to ration as well. Here’s how.
They will require “accountable care organizations (ACOs),” where “teams” work together to provide care. They will require “bundled” payments that cover “packages of care,” including pre- and post-care, home health, etc. The ACO will receive one payment and then allocate the money to the team members, who will likely be on salary. All of this is held together by Health IT that is plugged in to the Comparative Effectiveness mechanism. That will help the ACO alert team members when they try to do something that is not “evidence based.”
For example, if the salaried doctor (or more likely, nurse practitioner) tries to order an unauthorized medication on his computerized order form, a warning will pop up explaining it is unauthorized, and either forbidding the prescription or providing a “waiver of exception” form where he can document the extraordinary need.
There may be a transition period allowed, but after a few years (say, 5), only these ACOs will be allowed to participate in the Insurance Connector. But, since these are “private” companies, there will be no government rationing.
I think the words used in these blogs lack clarity and do not reflect the words in legislative language or intent. As such, people are left frightened by misperceptions. It is time to be more honest.
It was my understanding that ACOs are not required, they are offered. That primary payments did not change, only th eshared savings from performance were paid in aggregate and then distributed. All providers were otherwise paid as usual. HIT is only one of many, many tools to assist the ACO. And the example might be better stated that the unauthorized order could be approved with the patient’s knowledge and concurrence.
What would accountable care organizations look like – Cleveland Clinic, Mayo Clinic and more…
Frank, I don’t think the ACOs would look like Mayo. Even Mayo doesn’t know how to replicate Mayo. Instead they would be ordinary doctors pressured to follow a ccokbook, modeled after Mayo. As such, they would not be exercising their own independent judgment, but would be following guidelines written by people who have never seen the patient.
Do you want your medcial care to be administered from a cookbook?
When you give a government agency the power to set cost-effective guidelines for treating patients, you give them power to set forth their own agendas. The doctors that have already been appointed to this cost-effectiveness council have published literature that suggests they would implement age discrimination and other social justice guidelines in order to cut costs. In the medical ethics community there have been discussions on whether a healthy person should receive preferential treatment over a disabled person, whether a child with an education should receive preferential treatment over a child with none (because we’ve already spent money on educating him), or whether a person should be denied treatment if the illness is a result of their own negligence (smoking, overeating, drinking). A study in Sweden reports that officials were willing to allow 15 out of 100 preventable deaths in order to “even out” the death rate between blue collar and white collar workers. A government panel can look at the bottom line and deny care without seeing the individual. It’s much harder for a doctor to look you in the face and deny you what you need to survive. You may not think this would ever happen, but the only sure way to prevent it is to never have such a council. As a result of cost-effective rationing, British cancer patients do not have access to drugs that are routinely available in the United States. The World Health Organization (WHO) estimates that 25,000 British cancer patients die prematurely every year because of these restrictions. I am a breast cancer survivor. With cancer, years matter: often if you can survive an extra year or two, new treatments are developed that enable you to survive much longer.
Isn’t health care already rationed by insurance companies. They will pay x,y,z, and they will exclude a,b,c.
This is not much different than capitation except it seems the lump sum reimbursement will be based upon medical diagnosis. And yes, the goal is to engage in covert rationing where the physicians and other healthcare providers are given a lump sum payment to be doled out by some gatekeeper (either a hospital or primary care physician-some “accountable care organization”). This is similar to how Canada pays its physicians. The state wants to insert a disincentive for the healthcare provider to offer “expensive” medical care because such care will cut into the providers’ bottom line.
I watched the testimony of some health policy wonk on CSPAN not too long ago who stated this scenario precisely and who advocated explicit rationing saying either it is done by policy makers or by the medical care providers. This is why in Canada, the UK and others, the MD does not discuss the range of treatments available for a medical condition–only those regulated by the state.
The Author says-
“The Obama Administration doesn’t need a public plan to control costs. It can pressure private plans to ration as well. Here’s how.”
The only how needed is to leave ythe insurance companies alone. Rationing already exists and there is no need to “pressure” anyone. It isn’t just about what is accepted or excluded by insurance, but the plain and simple fact that the elderly are regularly told what tests and procedures they will and will not have. That if the medical tests are mandated by insurance, (often at the out-of-pocket expense of consumers), the consumer MUST comply or risk losing their coverage all together. Those who have pre-existing conditions (not covered under insurance for a full year), often find that EVERY medical expense is somehow pre-existing,(You have diabetes and go to the doctor for bronchitis and your bronchitis is somehow related to your diabetes and therefore not covered.) Also never forget that it takes MONTHS to get an doctor appointment that lasts 5 minutes, if your lucky.
I think the words used in these blogs lack clarity and do not reflect the words in legislative language or intent. As such, people are left frightened by misperceptions. It is time to be more honest.
It was my understanding that ACOs are not required, they are offered. That primary payments did not change, only th eshared savings from performance were paid in aggregate and then distributed. All providers were otherwise paid as usual. HIT is only one of many, many tools to assist the ACO. And the example might be better stated that the unauthorized order could be approved with the patient’s knowledge and concurrence.
What would accountable care organizations look like – Cleveland Clinic, Mayo Clinic and more…