If you are looking for something about the new healthcare plan, you may have found very little that is not technical and very hard to read and make sense from what the writer says. Accountable Care Organizations (ACO) are just that and why the bill passed. Our government will shortly control where the money goes and who gets treated and who does not.
This blog by John Goodman does an excellent job of laying out what is about to happen for us, the patients as well as our hospitals and doctors. The picture does not look good. Medical care rationing will be the name of the business and if they can determine that you are not following the rules, you may find yourself on the short list for medical care rationing.
Those of us that are past the age of 65 had long feared this, but now this may be expanded to people of all ages. Anyone that will use up resources (money) to be treated for chronic diseases will find themselves on the list for medical care rationing whether we desire to be there or not. Those outside the system can forget about medical care unless they have the money to pay for treatment and not draw support (money) from the ACOs.
ACOs are essentially HMOs on steroids. The medical insurance industry will not have a choice in how they insure as they will be required to have ACO plans. This will mean that if your doctor is not a member of an ACO the medical care will not be fully reimbursed and most likely you will not be able to get treated unless you can afford to pay the difference. Co-pays will then mean any part of the bill not covered.
This is how they were able to bypass the “universal healthcare” that the Congress and administration so desperately wanted. You will either have an “ACO plan” or you will not be treated unless you can afford to pay all costs.
Please read the blog by John Goodman.
Showing posts with label ACOs. Show all posts
Showing posts with label ACOs. Show all posts
15 March 2011
31 January 2011
Value of Health Care
At first I was considering just leaving this whole topic sit, but then the doctors had to start discussing it and basically doing nothing but quibbling. While I am not sure if I can add anything of value from a patient perspective, I would like to voice some concerns as a patient.
First, if doctors are so concerned with value, maybe patients should have more input. We may not be as independent or disinterested as a panel of stuff-shirted hospital board members or CEOs. We may have some concerns that are important to us and not the bottom line. I would suggest that missing is another New England Journal of Medicine (NEJM) article titled “Putting the Value Framework to Work”.
So I am drawing my ideas from two NEJM articles and one by Dr. R. Centor and comments to his blog. The second article mentioned by Dr. R. Centor is “What is Value in Health Care?” Dr. Centor's blog is “Measuring Value in Health Care”.
I must agree with Dr. Centor that “value” is a challenging topic. Patients should read it as well as doctors because this is something we will be facing in the near future and some are already involved and feeling the effects. I feel that Dr. Centor has taken the right path in discussing this in a positive manner. It is the law and will be part of our future for a while.
As such, Dr Center does correctly point out something in the article in the NEJM that is complex and has sophistication, and can be achieved. He also points out that the author of the NEJM article changes the focus to the patient and away from the system. This alone says volumes as too many doctors are so immersed in the system that they cannot see the patient. These doctors hide in the system so that they do not have to worry about the patient.
Dr Centor correctly points out that patients often have multiple physicians, use emergency departments, walk-in clinics, and hospitals. Patients do not use systems and may use physicians across several systems. The commentors are probably the doctors we want to stay away from. They seem ridged in their thinking and wanting to keep the current system. They are afraid that value means cost cutting which is not the object of the discussion.
Yes, value is often difficult to define under the current mode of operation. It will take getting out of the current system and probably into an Accountable Care Organization to make value something measurable and worth talking about. The ACOs are yet to be defined and may work, but there are some interesting questions still to be resolved.
Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.
First, if doctors are so concerned with value, maybe patients should have more input. We may not be as independent or disinterested as a panel of stuff-shirted hospital board members or CEOs. We may have some concerns that are important to us and not the bottom line. I would suggest that missing is another New England Journal of Medicine (NEJM) article titled “Putting the Value Framework to Work”.
So I am drawing my ideas from two NEJM articles and one by Dr. R. Centor and comments to his blog. The second article mentioned by Dr. R. Centor is “What is Value in Health Care?” Dr. Centor's blog is “Measuring Value in Health Care”.
I must agree with Dr. Centor that “value” is a challenging topic. Patients should read it as well as doctors because this is something we will be facing in the near future and some are already involved and feeling the effects. I feel that Dr. Centor has taken the right path in discussing this in a positive manner. It is the law and will be part of our future for a while.
As such, Dr Center does correctly point out something in the article in the NEJM that is complex and has sophistication, and can be achieved. He also points out that the author of the NEJM article changes the focus to the patient and away from the system. This alone says volumes as too many doctors are so immersed in the system that they cannot see the patient. These doctors hide in the system so that they do not have to worry about the patient.
Dr Centor correctly points out that patients often have multiple physicians, use emergency departments, walk-in clinics, and hospitals. Patients do not use systems and may use physicians across several systems. The commentors are probably the doctors we want to stay away from. They seem ridged in their thinking and wanting to keep the current system. They are afraid that value means cost cutting which is not the object of the discussion.
Yes, value is often difficult to define under the current mode of operation. It will take getting out of the current system and probably into an Accountable Care Organization to make value something measurable and worth talking about. The ACOs are yet to be defined and may work, but there are some interesting questions still to be resolved.
Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.
29 January 2011
ACOs – The fork in the Road
Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.
I am not sure of the value being assigned to this, but since it is part of the new law and at present still on the books, we should understand as much of it as is possible. I mean patients need to understand. We are the people who may have the most to benefit, or lose, by the new structures being promoted.
Do be concerned, as there are some dangerous flaws in the proposed models. Most will never be transparent and will be buried in technical and legal documents which we as patients, will never see. Accountable Care Organizations (ACOs) may continue to exist, but the rules and regulations governing them have yet to be defined.
It is going to be interesting to see what the organizations are going to look like. Are they going to be centered around hospitals, or will they be physician controlled, or will they be combinations of these? This is the interesting part. From my reading, it represents a jigsaw puzzle and may have small benefits for patients. The large benefits all seem directed to the physicians and hospitals.
There will be the small benefits to patients by reducing the duplicity of tests we now undergo, better (hopefully) care because physicians and hospitals will necessarily need to communicate more openly about patient care. This could translate into less errors foisted on patients. The large concern I see, will be how to handle doctors mistakes and they will have more layers of protection and harder to be dismissed for practice mistakes.
I will not make further questions until the form of the ACOs is actually known, but you can see many of them. There will be several more blogs about these and other problems with ACOs and their formation. These will be done as I decipher this area and learn more.
For those interested read this from the New England Journal of Medicine.
I am not sure of the value being assigned to this, but since it is part of the new law and at present still on the books, we should understand as much of it as is possible. I mean patients need to understand. We are the people who may have the most to benefit, or lose, by the new structures being promoted.
Do be concerned, as there are some dangerous flaws in the proposed models. Most will never be transparent and will be buried in technical and legal documents which we as patients, will never see. Accountable Care Organizations (ACOs) may continue to exist, but the rules and regulations governing them have yet to be defined.
It is going to be interesting to see what the organizations are going to look like. Are they going to be centered around hospitals, or will they be physician controlled, or will they be combinations of these? This is the interesting part. From my reading, it represents a jigsaw puzzle and may have small benefits for patients. The large benefits all seem directed to the physicians and hospitals.
There will be the small benefits to patients by reducing the duplicity of tests we now undergo, better (hopefully) care because physicians and hospitals will necessarily need to communicate more openly about patient care. This could translate into less errors foisted on patients. The large concern I see, will be how to handle doctors mistakes and they will have more layers of protection and harder to be dismissed for practice mistakes.
I will not make further questions until the form of the ACOs is actually known, but you can see many of them. There will be several more blogs about these and other problems with ACOs and their formation. These will be done as I decipher this area and learn more.
For those interested read this from the New England Journal of Medicine.
28 January 2011
Assessing an ACO Prototype
This New England Journal of Medicine article is about an accountable care organization (ACOs) that is physician managed. While this has been underway for some time, it is not fully operational under the new laws which seems to be hindering its operation. This has been a demonstration project sponsored by the Centers for Medicare and Medical Services (CMS).
But understand this was directed by Congress of the Department of Health and Human Services (DHHS). The aim was to improve the quality of care to Medicare beneficiaries and reduce its cost while using the incentive-based payment. Instead they used the fee-for-service payment system. This fee-for-services payment system is faulty to begin with so this is not a good example for what the future may hold for ACOs.
In 2000, Congress gave the DHHS the task of testing incentive-based payment methods for physicians. They directed Medicare to encourage care coordination and investment in processes for more efficient service delivery and to reward physicians for improving health care results. The demonstration actually began in April 2005 and apparently still continues.
On December 9, 2010, DHHS reported results from the project's fourth year ending March 31. 2009 and announced the payout incentives. Most of the quality goals were process measures related to coronary artery disease, diabetes, heart failure, hypertension, and preventive care.
CMS is now working to transition these physician groups into the ACO program established under the reform law The CMS is drafting regulations that will guide implementation of the Accountable Care Organization (ACO) program scheduled to begin January 1, 2012.
Many questions remain because the project used the fee-for-services payment and not the incentive-based payment as directed. Will this be corrected under the ACOs or will this be a legal issue for the courts to resolve. There are many other organizational questions to be answered, but this is for future blogs.
Read the details about this here.
But understand this was directed by Congress of the Department of Health and Human Services (DHHS). The aim was to improve the quality of care to Medicare beneficiaries and reduce its cost while using the incentive-based payment. Instead they used the fee-for-service payment system. This fee-for-services payment system is faulty to begin with so this is not a good example for what the future may hold for ACOs.
In 2000, Congress gave the DHHS the task of testing incentive-based payment methods for physicians. They directed Medicare to encourage care coordination and investment in processes for more efficient service delivery and to reward physicians for improving health care results. The demonstration actually began in April 2005 and apparently still continues.
On December 9, 2010, DHHS reported results from the project's fourth year ending March 31. 2009 and announced the payout incentives. Most of the quality goals were process measures related to coronary artery disease, diabetes, heart failure, hypertension, and preventive care.
CMS is now working to transition these physician groups into the ACO program established under the reform law The CMS is drafting regulations that will guide implementation of the Accountable Care Organization (ACO) program scheduled to begin January 1, 2012.
Many questions remain because the project used the fee-for-services payment and not the incentive-based payment as directed. Will this be corrected under the ACOs or will this be a legal issue for the courts to resolve. There are many other organizational questions to be answered, but this is for future blogs.
Read the details about this here.
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