Health Care thoughts: Defining an ACO
Health Care: Defining an ACO
Having recently plowed through about hundreds of pages on Accountable Care Organizations (ACOs) and Integrated Delivery Systems (IDSs), I should know how to define an ACO.
But I don’t know, not exactly. Using an old Supreme Court standard, I know one when I see it, I think, because of certain characteristics.
This is critical because the Obama administration expects to garner huge savings from providers working through ACOs, beginning for Medicare in 2012 (building such systems in less than 9 months is going to be a Herculean task)..
The best formal definition I have seen to date, and it is very general, is the CMS definition for Medicare ACOs, and I quote:
Q: What is an “accountable care organization.”
A: An Accountable Care Organization, also called an “ACO” for short, is an organization of health care providers that agrees to be accountable for the quality, cost and overall care of [Medicare] beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it (ACO).
It is a start, barely. The ACOs are supposed to be in place 1/1/2012. Administrative regulations were issued in November 2010 and the public comment period ended recently.
In a recent speech DHHS Sec. Berwick offered these “flag and apple pie” characteristics, still very general:
- the patient and family will be at the center;
- teamwork will now become “paramount;”
- respect resources and reduce waste;
- reinvest where investment counts;
- measure and manage outcomes partially through electronic health records; and
- establish a solid health care workforce foundation
Tom aka Rusty Rustbelt
Tom
I wish them luck. But from what I have seen the “providers” can always find rationalizations to do things that put more money in their own pockets.
And while I was never an on board fully committed fan of “single payer,” it has begun to seem to me that the facts of human psychology are such that you will never be able to control costs without something like an adversary system where the payer has the same clout as the payee.
my suggestion has been that health care be handled like highway construction: the government designs the specs and puts the project out for bids. selects the low bidder and monitors the contractor for compliance with specifications. during the process the government agency learns how to do the next project better or cheaper and incorporates that into the specs for the next job.
in the health care context i would imagine this means the government collects the premiums though a payroll tax dedicated to health insurance. designs a contract for a block of people selected for geographical convenience but NOT for “prior conditions.” existing insurance companies bid to handle the day to day just as they do now… but without the advertising or the complete freedom to game the marks… er, customers.
the combination of free market competition with the government as a knowledgeable buyer should be the best way to lower costs. i would hope that normal politics would keep the government honest.
The defense budget suggests i may be naive, but i think its worth a try.
less corruption = lower budget deficit
http://thekaufmannpost.net/wp-content/uploads/2010/04/crrptn-fiscal-dfct-1.jpg
lower deficit might permit more correct health care reform in this nation.
Corruption and Fiscal Deficits in Rich Countries
more complete – http://thekaufmannpost.net/corruption-and-fiscal-deficits-in-rich-countries/
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Sorry for the delay in responding. I am in Florida about to give a talk on health reform at a national meeting.
Anyway, here’s the requirements for an “ACO”:
“A formal legal structure that would allow the organization to recieve and distribute payments for shared savings to participating providers of services and supplies “
” Enough primary-care providers to handle at least 5,000 patients”
“A way of implementing ‘quality and other reporting requirements”
“A leadership and management structure that includes clinical and administrative systems”
“Processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies”
That’s it. Pretty vague. HHS is still writing the exact requirements.
It should be noted that in 2005, CMS sponsored a ten group pilot of ACO’s, and the average up front financial costs were 489,000, with 1.65 million needed for the first years costs.
8 out of the 10 saw no savings the first year. Which is making most institutions and health administrators very leery and a little cautious about ACO’s right now.
It will be interesting to see the final regulations from the HHS.
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This whole law is become more farcical as the days go by. DOJ slow rolling the court cases, the ensuing appeals, and getting slapped down by Judge Vinson, and after filing their ?expedited? appeal slapped down again by the 11th Circuit Court of appeals for slow rolling that step.
All the while we are seeing Health Insurance costs sky rocket, pilot projects showing: “8 out of the 10 saw no savings the first year. Which is making most institutions and health administrators very leery and a little cautious about ACO’s right now.” (M H above). Finally, the states are on the hool to invest tens to hundreds of billions in preparations to implement the HC Bill.
How can any Dem be proud of this bill and this administration’s implementation? Is this going to be Obama’s legacy?
This whole law is become more farcical as the days go by. DOJ slow rolling the court cases, the ensuing appeals, and getting slapped down by Judge Vinson, and after filing their ?expedited? appeal slapped down again by the 11th Circuit Court of appeals for slow rolling that step.
All the while we are seeing Health Insurance costs sky rocket, pilot projects showing: “8 out of the 10 saw no savings the first year. Which is making most institutions and health administrators very leery and a little cautious about ACO’s right now.” (M H above). Finally, the states are on the hook to invest tens to hundreds of billions in preparations to implement the HC Bill.
How can any Dem be proud of this bill and this administration’s implementation? Is this going to be Obama’s legacy?
I sat down after writing this and tried to flow chart a relatively simple community hospital based ACO in a mid sized city, and then do a Gantt chart for implementation. Wow.
This is gonna take an immense amount of work. Immense.
Michael: Your name is really familiar – how do I know you? Blogging?