Accountability? Heaven Forbid!


Originally published 1/10/11 on Running A Hospital

At a recent talk, Dartmouth’s Elliott Fisher facetiously remarked that we cannot yet be sure whether accountable care organizations (ACOs) will actually be accountable, caring, and organized. Well, if some providers have their way, they certainly won’t be accountable.

This story by Jordan Rau in the Washington Post relates comments being made as Medicare writes its rules governing the ACOs. Here are some quotes: 

More on the Global Reimbursement Deal Between BIDMC’s Physician Organization and BCBSMA

Here’s a follow-up to yesterday’s Paul Levy article about the global reimbursement arrangement between the 1800 physician Beth Israel Deaconess Physician Organization and Blue Cross and Blue Shield of Massachusetts’. This video interview and accompanying article are with Dr. Stuart Rosenberg, a “Payment Reform Experimenter-in-Chief.”

BIDMC Doctors and BCBSMA Go Global


Originally published here on 12/10/10 on Running A Hospital

Brian’s Note: I saw this early today and immediately asked Paul permission to run it. To my mind, this is a VERY important development, very positive intent that has been translated into action early on. Worth your time.

This story by Martha Bebinger at WBUR relates the fact that our physician group has joined with Blue Cross Blue Shield of Massachusetts in a new form of payment contract. Instead of being based on a fee-for-service rate structure, it is based on an annual average budget per patient, with bonuses offered for specific quality metrics and specific patient satisfaction scores.

As noted by BCBS CEO Andrew Dreyfus in the video below, BIDPO is the largest physician organization in the state to sign such a contract. Its membership includes all of the faculty at BIDMC, but also hundreds of primary care doctors and specialists in several community hospitals, private practice, and community health centers. Getting this variety of doctors to reach a consensus on the desirability of such a contract took education, time, and patience on the part of the BIDPO leaders, and particularly Dr. Stuart Rosenberg, the group’s CEO. Stuart strongly felt that the BIDPO doctors should take the lead in delivering care based on a strong foundation of primary care, local delivery of service, and controlling the growth in costs.

One of the impacts of this kind of contract will likely be a reduction in certain services provided by BIDMC, either eliminating them altogether or delivering them at lower cost sites in the community. This makes sense from a societal point of view, and we welcome that result. Our business plan is not based on carrying out more and more procedures per patient: It is to become the destination of choice for patients who truly need tertiary care, but who want it delivered in a safe, high quality, and efficient environment — a place that can substantiate its progress on those fronts by publication of clinical outcomes and other metrics for all to see — and a place that closely coordinates care with our clinical partners in the community.

See the video below.