Don’t Kick a Unicorn When It’s Down

David Harlow

First published 6/3/11 on Health Blawg

400px-WLA_metmuseum_1495_Unicorn_captivityThere has been a significant outcry against the proposed ACO regs: everything’s wrong and nothing’s right about them, or so some would have us believe.  (The comment period is still open, and CMS is still soliciting input; much of the outcry is a form of posturing and negotiation … not that there’s anything wrong with that.)

Today’s “nattering nabobs of negativism” focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure incuded), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, the premature pledging of allegiance to an idea only partly proven through the PGP demo, the likelihood of failure due to the whole endeavor’s being tied to FFS reimbursement, on the one hand, and due to exposure of ACOs to downside risk, on the other, the unreasonable reliance on dozens and dozens of quality measures . . . and the list goes on.  For further detail, see, e.g., David Dranove’s recent post decrying unproven theories baked into the ACO program (with a link to info on the PGP demo’s results, and differing interpretations of those results; check out the lively discussion in the comments to Dranove’s post on The Health Care Blog), Jeff Goldsmith’s opposition to ACOs as conceived in the ACA (and alternative proposal discussed in the linked post), and Mark Browne’s search for a few good quality measures. (This has been a recurring theme for me as well; I would love to find six or eight meta-measures that predict all others; Mark links to the AHA’s comments on the ACO rule, which are worth a read).

Continue reading “Don’t Kick a Unicorn When It’s Down”

Is the ACO DOA? Reasonable Minds Can Improve the Draft Regulations

David Harlow

First published 5/17/11 on HealthBlawg

In the current all-ACO, all the time, health care policy news cycle, we’ve been inundated with declarations that the ACO is dead, because a handful of big boys say they don’t want to play.http://healthblawg.typepad.com/

Today, CMS announced that it is tinkering with the proposed ACO rules by offering three variations on the ACO theme (link to press release; see also CMS ACO fact sheet).  From the fact sheet:

Continue reading “Is the ACO DOA? Reasonable Minds Can Improve the Draft Regulations”

Cheryl et al Report on CMS’ ACO Regulations

Paul Levy

First published 5/11/11 on [Not] Running a Hospital

Cheryl Clark and her colleagues at HealthLeaders Media have put together a special report on the industry’s response to CMS’ proposed Accountable Care Organization regulations. This a helpful survey that supplements unsupported comments from people like me. Let’s start with a reminder of the general scope of the regulations:

Groups of ACO professionals with a minimum of 5,000 beneficiaries would be permitted to apply for one of two risk models in order to benefit from shared savings over the three-year program. In the first model, providers would share savings of 50% in all three years, but would be at risk in year three for any losses that exceed 2% of the benchmark established by the Centers for Medicare & Medicaid Services.

Continue reading “Cheryl et al Report on CMS’ ACO Regulations”

ACO Rules “Impenetrable”

Merrill Goozner

First published 4/19/11 at Gooz News

Michael Millenson, a health care consultant who many moons ago worked as I did at the Chicago Tribune, has offered a scathing critique of the Center for Medicare and Medicaid Services’ proposed rules for setting up accountable care organizations (ACOs), which are health care reform’s primary delivery system reform. Says Millenson on the Health Care Blog:

Continue reading “ACO Rules “Impenetrable””

ACO Fairy Tale Faces a Rumpelstiltskin Moment

Michael Millenson

First published 4/19/11 on Kaiser Health News

The ACO fairy tale is drawing perilously close to an unhappy ending.

The government’s long-awaited draft regulations on Accountable Care Organizations have brought a dose of ugly reality to a concept that’s always seemed coated with a patina of pixie dust. Unless those regs are substantially changed before the clock strikes Jan. 1, 2012 — the statutory date for ACO implementation — Cinderella’s going to turn back into a scullery maid and the horse-drawn carriage transporting her to the Health System Transformation Ball will be revealed as nothing more than four mice and a pumpkin.

Continue reading “ACO Fairy Tale Faces a Rumpelstiltskin Moment”

Changing the Game on Health Care Costs

Robert Laszewski

First published 4/10/11 on Health Policy and Marketplace Review

Last week, I posted that I was disappointed in Paul Ryan’s health care budget proposal because it lacked cost containment ideas other than the usual conservative reliance upon the market and defined contribution health care.

In my last post, Why ACOs Won’t Work, I argued that the latest health care silver bullet solution, Accountable Care Organizations (ACOs), are just a tool in a big tool box of care and cost management tools. But, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.

How do you make the American health care system efficient?

You change the game.

Continue reading “Changing the Game on Health Care Costs”

Why ACO’s Won’t Work

Robert Laszewski

First published 4/7/11 on Health Policy and Marketplace Review

First, I think Accountable Care Organizations (ACOs) are a great idea. Just like I thought HMOs were a good idea in 1988 and I thought IPAs were a good idea in 1994.

The whole notion of making providers accountable for balancing cost, medical necessity, appropriateness of care, and quality just has to be the answer.

But here’s the problem with ACOs: They are a tool in a big tool box of care and cost management tools but, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.

Continue reading “Why ACO’s Won’t Work”

Accountable Care Organization (ACO) Regulations: First Look

David Harlow

First published on 4/3/11 and 4/5/11 on Health Blawg

ACO regulations and related federal issuances hit the street last Thursday, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS.  They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to  limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt organizations.

I had the opportunity to discuss the regs the day after they were issued on a special edition of the Blog Talk Radio show, ACO Watch, hosted by Gregg Masters(@2healthguru).  Gregg’s guests included Mark Browne (@consultdoc), Vince Kuraitis(@VinceKuraitis), Jaan Sidorov (@DisMgtCareBlog) and yours truly (@healthblawg).  We are geographically diverse, and bring a variety of perspectives to the table.  I invite you have a listen — we enjoyed the opportunity to discuss the rules, we all learned from each other, and we hope you enjoy the conversation as well.  (It runs about 90 minutes.)

Continue reading “Accountable Care Organization (ACO) Regulations: First Look”

Tire Kickers Need Not Apply – 8 First Impressions of the Medicare ACO Rule

Vince Kuraitis

First published 4/1/11 on e-Care Management

On March 31, CMS released the long-awaited “Medicare Shared Savings Program: Accountable Care Organizations” document (ACO Rule). Read the details here (strong suggestion: unless you’re working on your PhD in ACOs, start with the fact sheets).

There are many surprises. Here are eight first impressions on this 429 page tome:

  1. The bar has been set high…very high.  Tire kickers need not apply.
  2. Don’t expect to see many or any small ACOs.
  3. Patients will be confused by ACOs.
  4. Concerns over maintaining competition and avoiding antitrust are being taken seriously.
  5. CMS scores points for coordinating the ACO Rule across Federal agencies.
  6. CMS loses points for micromanagement and a controlling mindset.
  7. Possible losers — hospitals, ACO vendors.
  8. Possible winners — physicians, health plans.

The details follow.

Continue reading “Tire Kickers Need Not Apply – 8 First Impressions of the Medicare ACO Rule”

FAQs on Accountable Care Organizations

Jenny Gold

First published 3/31/11 on Kaiser Health News

Accountable care organizations take up only seven pages of the massive new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.

Ignoring Primary Care, Obscuring The Obvious

Jeff Cohen

First published 3/24/11 on ACO Watch

Healthcare reform used to imply just regulatory change.  As time marches on, it also implies market change.  Most pundits agree that, whatever happens to the healthcare reform law, whether or not it is found to be unconstitutional, the healthcare business community is unleashed.  Change is afoot!

If you follow my naysaying on the issue, then you know I believe the expectations regarding ACOs are overblown and unrealistic.  Martians will not land here en masse, although there may be an occasional stow away on a NASA craft.  Put another way, as some others have said, ACOs are like unicorns—magical, mythical beasts that no one has ever seen.  I don’t expect many to come prancing around in Florida, at least not South Florida, anytime soon.

Continue reading “Ignoring Primary Care, Obscuring The Obvious”

The Missing Link in ACOs: Patients

Mark Lutes and Joel Brill

First published 3/15/11 on Kaiser Health News

In 2009, researchers reported the discovery of “Darwinius masillae,” a small lemur-like creature that lived some 47 million years ago. Many paleontologists have postulated that D. masillae was the missing link, marking the point at which the evolutionary lineage of humans diverged from that of more distant primates.

It seems to us that, in the recent debate about accountable care organizations, one could also detect a missing link.

ACO’s: Missing Accountability from a Very Critical Stakeholder

Wendy Lynch

First published 3/10/11 on the Altarum Institute Blog

Imagine you decided to run an Accountable Car-Care Organization.  The government announced you would no longer be paid on repairs alone, but for keeping cars on the road and out of the garage. You might contract with qualified teams of mechanical providers, from oil-change garages for preventive maintenance, tow-truck drivers for emergencies, to specialist mechanics for very technical repairs.  Next, you assemble secure, integrated information technology to track the care each automobile receives across providers and assign each license plate number to a vehicle-centered mechanical home. Finally, you determine specific outcomes and standards of practice to keep engines running better. Under ACCO rules, you are ready to start earning performance bonuses.  Right?

Continue reading “ACO’s: Missing Accountability from a Very Critical Stakeholder”

Measuring Patients’ Experience of Care

DAVID HARLOW

First published 2/9/11 on Health Blawg,

There is a growing recognition within the medical-industrial complex that the patient is a key element of the enterprise, and that patient satisfaction, patient experience, patient engagement, patient activation, patient-centeredness are very important.  Some research shows that patient activation yields better patient outcomes, and that patient activation can be measured.

Patient-centeredness and patient engagement are two of the key metrics to be used by the feds in describing Accountable Care Organizations (ACOs), if the internecine battles within government are resolved soon enough to actually release draft ACO regulations in time to allow for sufficient advance planning for the January 2012 go-live date.  (Wearing one of my many hats, I’ve had the opportunity to submit a response to CMS regarding the RFI on these metrics on behalf of the Society for Participatory Medicine.)  These measures go into the Meaningful Use hopper as well, as Meaningful Use Stage 2 metrics are being reviewed.

Continue reading “Measuring Patients’ Experience of Care”

ACOs and Anti-Trust

MERRILL GOOZNER

Originally published 1/3/11 in The Fiscal Times

Beyond the legal challenges, a major new hurdle is emerging for the health care reform law. Recent studies show that the major players in the health care marketplace – insurers, hospitals and physician practices – are consolidating, which increases the likelihood they will collude on prices charged to employers and to consumers and defeat cost control measures in the law.

Continue reading “ACOs and Anti-Trust”