Tag Archives: ACOs

Physicians

Fifty Percent Increase in Share of Physicians Owned By Hospitals in Three Years

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Confident DoctorsA new survey by the Physicians Advocacy Institute and Avalere Health, a consulting firm, shows a significant increase in the number of physicians leaving independent practice and joining hospital-based health systems:

  • From July 2012 to July 2015, the percent of hospital-employed physicians increased by almost 50 percent, with increases in each six-month period measured over these three years.
  • In 2012, one in four physicians was employed by a hospital.
  • By 2015, 38 percent of physicians were employed by hospitals.

Good or bad? Well, color me skeptical. This acquisition spree is driven by new payment models which seek to reward providers for “accountable” care (which I suppose is better than unaccountable care.) So far, the results of payment reform in Medicare have been trivial. Continue reading Fifty Percent Increase in Share of Physicians Owned By Hospitals in Three Years →

Medicare

Medicare Accountable Care Organizations Continue to Underwhelm

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Confident DoctorsMedicare’s Accountable Care Organizations (ACOs), which launched in 2012, were supposed to introduce a significant shift away from paying for “volume” to paying for “value.” Critics of Fee-For-Service medicine claim this system causes physicians to do more to patients so they get paid more, notwithstanding benefits to patients. Those critics seldom identify the moral hazard associated with third-party payment (by insurers or governments) as a cause of too many medical tests or procedures.

So, they introduced ACOs, which would increase quality and cut costs by getting rid of straight Fee-For-Services and putting more financial risk on physician groups. If the physician groups pass certain thresholds of cost and quality, they can pocket some of the savings. The 2015 results for Medicare’s ACOs have been reported, and the results are underwhelming: Continue reading Medicare Accountable Care Organizations Continue to Underwhelm →

New Health Care Law

Another Obamacare Architect Recognizes Its Unintended Consequences

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KocherDr. Bob Kocher, an Obamacare architect turned venture capitalist, has admitted the law has had a significantly negative unintended consequence:

When I joined the Obama White House to advise the president on health-care policy as the only physician on the National Economic Council, I was deeply committed to developing the best health-care reform we could to expand coverage, improve quality and bring down costs.

What I got wrong about ObamaCare was how the change in the delivery of health care would, and should, happen. I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA.

Well, the consolidation we predicted has happened: Last year saw 112 hospital mergers (up 18% from 2014). Now I think we were wrong to favor it.

(Bob Kocher, “How I Was Wrong About Obamacare,” Wall Street Journal, July 31, 2016.)

Continue reading Another Obamacare Architect Recognizes Its Unintended Consequences →

Health Alerts

Bipartisan Agreement to Destroy Medicare As We Know It, But Not Quickly Enough

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care-home_2063592b(A version of this Health Alert was published by Forbes.)

Last week, the Centers for Medicare & Medicare Services announced by it had beat its target of tying 30 percent of Medicare Part A and B payments to “quality of care rather than quantity of services.” That goal was initially set for the end of 2016, but was actually achieved in January.

Initially, this was a goal set only by administrative fiat, in January 2015. However, it soon picked up bipartisan legislative support in the so-called “doc fix” bill of April 2015. The Administration has a goal of tying 90 percent of payments to “quality” by 2018 and it now looks like this is a realistic target.

Another way to describe paying for “quality of care rather than quantity of service” could be “plotting to destroy Medicare as we know it,” although the politicians who brought this about would not use those words. On the contrary, Republican and Democratic politicians accuse each other of plotting to destroy “Medicare as we know it” when campaigning against each other, because they know that is the easiest way to scare granny at the voting booth. Continue reading Bipartisan Agreement to Destroy Medicare As We Know It, But Not Quickly Enough →

Medicare

Are Medicare ACOs Gaining A Foothold?

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man-in-wheelchairThis blog has never gotten very excited by Medicare’s Accountable Care Organizations (ACOs). ACOs are risk-sharing arrangements between Medicare and providers, which are supposed to save money through efficiency. As a concept, they are fine – certainly an improvement over the incumbent, Soviet-style fee schedule. However, it is unlikely that the government has the incentives to get the risk-sharing incentives right.

I had anticipated that ACOs might end “with a whimper.” The Centers for Medicare & Medicare Services (CMS) have released results of Pioneer ACO’s third year of operation and 2014 results for Medicare Shared Savings Program (MSSP) ACOs which launched in 2012 through 2014. While ACOs are hardly taking off like the administration hoped, they seem to have gained a foothold. Continue reading Are Medicare ACOs Gaining A Foothold? →

Medicare

Bundled Payments, Barely Hatched, Go the Way of the Dodo

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man-in-wheelchairLast month, I wrote about Accountable Care Organizations (ACOs), medical groups accountable to the federal government for management of healthy populations. Even Zeke Emanuel recognizes that they are failing. Dr. Emanuel advised Medicare should “lump together” all the services associated with a procedure, such as a hip replacement, and pay one fee for the entire services.

As I noted, Medicare already does this via its Bundled Payments for Care Initiative (BPCI) which launched in 2013. At the time, hospitals and other providers were offered voluntary participation. Just a few weeks ago, the Medicare decided to make bundled payments mandatory for some procedures in some areas. Now we know why: Providers are learning that the bundles don’t work. Continue reading Bundled Payments, Barely Hatched, Go the Way of the Dodo →

Science and Other News

Obama’s Former Health IT Czar Raises $35 Million for New Venture

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FMBow-tied and charismatic, Dr. Farzad Mostashari, who led the Office of the National Coordinator of Health IT (ONC) from April 2009 to October 2013, has raised a total of $35 million from leading venture capitalists for his new business, Aledade. Aledade’s senior management includes veterans of athenaHealth and Practice Fusion, both firms which I admire for their entrepreneurship and relative (although not perfect) independence from government.

Like those firms, Aledade will provide its Electronic Health Records to independently practicing physicians. Aledade claims its uniqueness lies in an EHR that will ensure doctors’ win the Accountable Care Organization game. At NCPA, we think that ACOs are unlikely to succeed. Nevertheless, if anyone can pull this off, Dr. Mostashari and his team have got a pretty good edge (in my humble opinion). Continue reading Obama’s Former Health IT Czar Raises $35 Million for New Venture →

Medicare

Doctor Who Billed Medicare Over $16 Million in 2013 Explains It on YouTube

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Last year, I had a very rare opportunity to congratulate the Obama Administration for its decision to release Medicare’s physician payment data for public scrutiny. It followed up quickly with a data dump of hospital claims.

I also anticipated that this would lead the physicians with the highest spending to justify their claims to the citizens at large. Last week, the Administration released the 2013 physician file, which is causing a this to happen. Here is one high-cost specialist explaining his practice on YouTube:

I discovered this thanks to USA Today, which has done a first cut of the 2013 dataset: Continue reading Doctor Who Billed Medicare Over $16 Million in 2013 Explains It on YouTube →

Medicare

Accountable Care Organizations Hate Medicare’s Final ACO Rule

Confident DoctorsLast Thursday, the Centers for Medicare & Medicaid Services published the final rule for Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs). At almost 600 pages, it differs in many ways from the proposed rule issued last December:

  • Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
  • Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.

“Successful features of the Pioneer ACO model”? That’ll be a struggle. As we’ve discussed, the Pioneer ACOs have had very meager results, and will probably end up as a footnote to Medicare’s history. Continue reading Accountable Care Organizations Hate Medicare’s Final ACO Rule →

Physicians

Medicare Accountable Care Organizations Cut Spending Two Thirds of One Percent

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man-in-wheelchairThe Center for American Progress, previously a very pro-Obamacare organization, has published a study summarizing results of one of Obamacare’s most hyped tools to wring savings out of Medicare:

We first calculated overall savings by the Pioneer ACOs, finding that they reduced overall spending by 0.67 percent compared with the target amount of spending in the model’s second year.

Underwhelming, to say the least, don’t you agree?

In Forbes, Sally Pipes of the Pacific Research Institute cuts through the promotional rhetoric on ACO’s:

In the Obamacare case, the administration hand-picked the providers that could participate in the ACOs to maximize the chance of success. And even then, 13 of the original 32 organizations dropped out as a result of the program’s punishing complexity and costly regulations.

Most providers refused to join in the first place. Organizations such as the Mayo Clinic and the Cleveland Clinic — hospitals that President Obama has touted as excellent models of integrated care — declined to participate.

No wonder doctors are deeply skeptical of this model. A survey from the Physicians Foundation found that only one in ten actually think ACOs can improve quality while cutting costs.