Into the Lion’s Den
On Tuesday, I will appear at a Brookings Institution conference on Accountable Care Organizations (ACOs). As far as I can tell everyone else on the program believes in “evidence-based medicine,” while I will be the only advocate of “evidence-based public policy.”
My message: the latest comprehensive review of all the studies of report cards and other quality-measuring-and-reporting techniques finds they don’t work and may do more harm than good; the latest comprehensive review of all the studies of electronic medical records finds they do not live up to their promises; and the most recent study of pay-for-performance finds that it doesn’t work either.
What does work? Within the third-party payer system, islands of excellence are distributed randomly and do not appear to have characteristics that can be replicated by others. Outside the system, however, providers compete on price and quality; transparency is the rule, rather than the exception; and low-cost, high-quality medicine is the norm.
Solution: Let patients control the marginal cost of their care, wherever possible. At a minimum, Medicare should let the private sector find the improvements and pay providers a portion of any savings for the taxpayer.
This conference will be webcast here.
I believe part of the reason Pay for Performance and Health IT have both not fared better in report cards and demonstration programs is because the payers (government and insurers) are trying to impose these on providers from the top down. We really need providers figuring out how to adopt these programs in ways that best meet their needs and solve a problem rather than arbitrarily adopting them without integrating them into the practice.
Good luck!
Would I as a patient want to be treated by an ACO? What would be my incentive?
Would I as a doctor want to be in an ACO?
What would be my incentive?
If ACOs are going to avoid patient selectivity, and aren’t just going to end up paying more to provider groups with allegedly better records: then Medicare patients surely will be randomly assigned to them (and have no choice).
John,
Since HMO’s do work, why do you think ACO’s wont? They operate on the same principal.
Give ’em hell!
Erik, you are right. An ACO is an HMO. They have been described as HMO’s on steroids.
John, giv’em hell.
The webcast feature works wonderfully. Worth watching.
Saw it all. Great performance.
What I did not understand, until I listened to some of those guys, is that what they really want is HMOs with global budgets. While they talk a lot about quality and patient satisfaction, what they are really all about is rationing care.
ACOs are really little National Health Services under another name.