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:

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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.

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A Primary Care Revolt

Richard Reece MD

First published 4/17/11 on MedInnovation Blog

An under-the-radar revolution is going on out there. It is a  revolt of primary care physicians against the AMA and CMS.  It is a request for parity with specialists.  It is a movement to replace how primary care practitioners are paid.

Why the revolt against the AMA and CMS? Because primary care doctors yearn to correct myths about primary care vis-à-vis specialists, and because they believe, by altering how the AMA and CMS pay doctors, health costs can be brought down, and primary care can be re-invigorated.  Health systems with a broad primary care base have lower costs. In the U.S., two-thirds of doctors are specialists, and one-third are in primary care, the reverse of most nations, which have 50% or lower costs.

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A Letter From America’s Medical Specialty Societies To Rep. McDermott (D-WA)

Brian’s Note: This letter, signed by 47 medical specialty societies, was sent Wednesday to Rep. Jim McDermott (D-WA), in response to his remarks before the House Ways & Means Committee, and to legislation he recently introduced, H.R. 1256, the Medicare Physician Payment Transparency and Assessment Act, that would require the Relative Value Scale Update Committee’s (RUC’s) recommendations to be validated using means that are external to the RUC.

This letter, representing virtually the entire medical specialty community, is a remarkable display of mobilized discipline and influence over a seemingly minor bill. Note that the arguments in it echo those made last week by Barbara Levy, MD, the RUC’s Chair, in an article published on Kaiser Health News (which I responded to here). It is also similar to a letter – see here – sent Tuesday by AMA CEO Michael Maves.

More on this shortly.


April 6, 2011

 

The Honorable Jim McDermott

U.S. House of Representatives

1035 Longworth House Office Building

Washington, D.C. 20515

 

Dear Rep. McDermott:

On behalf of our physician members who care for the full range of patient needs, the undersigned organizations write to respond to comments made during the March 15, 2011 hearing before the Ways and Means Subcommittee on Health to discuss the Medicare Payment Advisory Commission (MedPAC) March 2011 Report to the Congress: Medicare Payment Policy and to share concerns regarding the “Medicare Physician Payment Transparency and Assessment Act”, recently introduced by Representative Jim McDermott. Specifically, we want to address the apparent misconceptions about the composition and role of the American Medical Association’s Relative Value Update Committee (RUC).

The RUC is a multispecialty physician expert panel convened by the AMA with the support and cooperation of the physician and health care practitioner specialty societies who petition the government to provide a fair and equitable system of reimbursement for physician services. In addition to annual updates reflecting changes in Current Procedural Terminology (CPT), Section 1848(C)2(B) of the Omnibus Budget Reconciliation Act of 1990 requires the Centers for Medicare and Medicaid Services (CMS) to comprehensively review all relative values at least every five years and make any needed adjustments. The success of the RUC’s role in the annual updates led CMS to seek assistance from the RUC for each of the three Five-Year-Review processes. CMS participates in every RUC meeting. After each review is completed, the Secretary of Health and Human Services and CMS review the RUC’s recommendations and will then accept, modify, or reject any of the recommendations.

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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.

Fixing the Failure At Physician Compare

MICHAEL MILLENSON

Originally published 1/28/11 on Kaiser Health News

The launch of Medicare’s Physician Compare website at year-end should have been a watershed event in the long campaign for health care transparency and patient empowerment. Instead – and it pains me to write this – Physician Compare is a case study in how the interests of the average citizen can be shunted aside by indifferent government, lazy journalists and solipsistic special interests. That remains true despite all of those involved being Good People Trying To Do The Right Thing.

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