Accountable Care Organizations (ACOs) have been likened to
a unicorn — a fantastic creature that is vested with mythical powers. But no one has actually seen one.
a camel — a horse designed by a committee, one that already has its nose in the tent
With this background, you can begin to appreciate the difficulty of conducting an accurate census of ACO animals in the wilderness. Yet, this is exactly the task undertaken in the excellent Leavitt Partners report measuring ACO activity in the US.
As I will explain, the Leavitt report has the potential both to overestimate and underestimate ACO and accountable care-like activities. In my judgment, however, it’s far more likely to be understating just how much accountable care activity actually is going on.
Physicians face great uncertainty. According to a survey conducted byThe Physicians Foundation, the great majority of physicians (89%) believe the traditional model of independent private practice is either “on shaky ground” or “is a dinosaur soon to go extinct.”
In the face of this uncertainty, many physicians are jumping to a conclusion that “I have to sell my practice to the hospital.” In this post of our series on The 100 Year Shift, we will examine physician practice. We’ll show that the economic and clinical environment is changing rapidly and that selling to the hospital is one option. However, it is not the only option.
This afternoon CMS announced the Bundled Payments for Care Improvement Initiative (BPCII). For details, start reading here.
Here are six quick first impressions:
1. It’s very creative and innovative. CMS has demonstrated out-of-the-box thinking and leaves a lot of room for applicants to propose their own approaches. Expect to have to read the materials 2-3 times to wrap your thinking around it.
Unlike the Medicare Shared Savings ACO rule, the BPCII is flexible. Expect some innovative and non-traditional proposals from diverse applicants. Unlike the Medicare ACO Shared Savings rule, the BPCII invites flexibility in:
Definition of care bundles
Proposal of specific financial terms
Participation by diverse care providers (see below)
In our introductory posting of this series, we noted that economic incentives previously aligning doctor-hospital interests were changing. This creates the potential for The 100 Year Shift – physicians awakening to possibilities for stronger partnerships with payers than with hospitals.
In this post, we will zero in on the changing economic position of hospitals and the effect this is having on physician-hospital relationships. We will examine the trend of hospital employment of physicians and point out challenges and tensions for the future. [This is a long post…so now might be the time to refill your coffee cup.]
This is the 2nd installment in a series on the Strategic Realignment among Physicians, Hospitals and Payers
In our introductory posting, we suggested that a huge shift is underway in the health care industry. Decades of hospital-physician cooperation are not only eroding, we suggest this trend could accelerate. Instead of a natural clinical and economic affinity with hospitals, we foresee the potential for physicians forming a new dyad with insurer-buyers.
In this post, we will examine what we and many other commentators view as inevitable: the demise of volume-based payment systems and how the drive for greater value will cause physicians and insurers re-examine their normally antagonistic relationship.
Gazing at the horizon, we foresee the potential for a tectonic realignment among physicians, hospitals and payers. Here’s a quick visual representation:
This essay is the first of a seven part series. In this first post we will capsulize our vision of this potential 100 Year Shift, answer initial FAQs, and lay out the structure for the rest of the series.
Why have hospitals increasingly been buying physician practices? Are these marriages based on true love or convenience? Will these marriages survive?
To address these questions, let’s take the long view (50–100 years) and revisit 7 assumptions that have driven us to today’s healthcare non-system:
Healthcare payment systems have rewarded piecemeal work.
Despite uneasiness, hospital-physician relationships have been cooperative.
Physicians can function effectively in small/medium size practices.
The healthcare mindset: built on control, not collaboration.
Barriers to sharing patient info and coordinating care are high.
The hospital has been the economic bedrock of the community.
Health plans are the bad guys.
For more details and discussion, tune in to tomorrow to BlogTalk Radio. Host and ACO guru Gregg Masters will be interviewing me and we’ll discuss the topic of “Is Hospital-Physician Integration Sustainable?”
Wednesday May 11th 2011 broadcast, at 11AM Pacific/2PM Eastern
Healthcare needs positive role models for innovation…and we have a real-time mentor in Netflix.
If you have a Netflix subscription, you probably identify with the company as providing a convenient DVD rental service — order on the web, the DVD arrives by mail, send it back in the handy pre-paid envelope when you’re done.
Today’s ReadWriteWeb describes Netflix’ latest letter to shareholders and explains how the company is preparing for the demise of DVDs:
By now most people understand the promise of pharmaceuticals being customized to “YOU” based on your individual genetic code. While this isn’t prevalent today, we understand that this will be possible in a few years.
Let’s take a minute to consider the mechanics of how this will occur. You’ve received a prescription, and it directs the pharmacist to tailor the medicine to YOUR genetic profile.
Consider two possible scenarios of how this transaction might happen. You’re on the phone with your pharmacist:
“OK, you need my DNA sequence. I keep my genetic profile in my mattress…let me get it and I’ll read it out loud to you. C, A, T, G, G, A, T… no, that was actually a G…let me start over. C, A, T, G, G, A, T… (19 hours later) … T, and G. Can you read that back to me to make sure you got it right?”
“You have permission to access my DNA sequence at my health URL (or maybe a health record bank, or perhaps hand her a flash drive, or ??).
Regular readers know that I find Professor Clay Christensen’s theory of disruptive innovation to be a useful lens to explain industry evolution. Let’s look at two recent health IT initiatives and see why one is working and the other is stalled.
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:
The bar has been set high…very high. Tire kickers need not apply.
Don’t expect to see many or any small ACOs.
Patients will be confused by ACOs.
Concerns over maintaining competition and avoiding antitrust are being taken seriously.
CMS scores points for coordinating the ACO Rule across Federal agencies.
CMS loses points for micromanagement and a controlling mindset.