Health Care Thoughts: Accountable Care "Smackdown"</
by Tom aka Rusty Rustbelt
Health Care Thoughts: Accountable Care “Smackdown”
The American Medical Group Association represents about 400 very large and sophisticated multi-specialty physicians groups, such as the Cleveland Clinic group and Intermountain (Utah) group.
The Obama administration had counted on these groups to be the first to create Accountable Care Organizations (ACOs), starting with Medicare ACOs in 2012 and then moving to full service ACOs. These groups were more likely to have the huge resources necessary to start an ACO.
On Wednesday the group announced 90% of its members would not participate, because the draft regulations issued March 31st were too prescriptive, too operationally complex, the move to risk sharing is too quick, the gatekeeper and risk management capabilities too much, and the time line too short. The AMGA consensus is the chance of success is close to zero, so why waste resources.
(see my post of 4/6/11: http://www.angrybearblog.com/2011/04/health-care-thoughts-aco-draft.html)
Not to pat myself on the back, but I just finished two papers with essentially the same comments. I’m not that smart, the flaws are just so terribly obvious to anyone with operations or insurer/risk management experience.
If the big 400 cannot chew through this and come up with a workable plan, neither will other physician groups. Based on recent conference attendance many provider organizations are taking the slow down approach.
It appears today only very large very integrated systems owning all of the necessary providers will be in the first wave. This could change for the better, but I doubt it. This could change for the worse though.
Not enough ACOs, no significant cost savings with quality improvement, no deficit improvement, train wreck.
Too complex, too controversial, too close to be unconstitutional, and too little actual cost savings, all to expand Federal Government control over a critical portion of the economy which most users thought was performing adequately to well. all of this was wrapped up into one of the most poorly written, organized and politically motivated bills to make it anything less than a “train wreck.”
Good job Rusty!
i don’t have any thoughts on the constitutionality of this particular aspect of the bill.
Here’s another unanticipated consequence of MA-care.
‘Universal’ care: Fast-track to the E.R.
“Internists and family practitioners report being so overwhelmed — too many patients, too much time pressure — that more than half are closing their practices to new patients.
…
The most important healing moments occur during an extended visit when a doctor listens carefully.
But this type of visit is on track to become extinct for all but the wealthy — choked off by the expanded entitlements and regulations of ObamaCare.”
Listen to the video.
Particularly stay around for the GAO comments.
Bernie Sanders is pushing health as a human right.
Sen Pauls says it would make doctors “slaves”. About as ill informed as Friedman saying draftees are slaves.
http://sanders.senate.gov/newsroom/media/view/?id=e17fb06c-af57-4203-9622-35cd61ec3b3d
Enjoy!
The Pauls are entertaining in a weird sort of way, but should never be allowed to have grown up jobs – too wacky.
Rusty,
Good post and good call.
Not enough ACOs, no significant cost savings with quality improvement, no deficit improvement, train wreck.
Whatever theoretical merits it might have had when the can-do technocrats cooked it up, by the time it’s been massaged through the legislature and pumped full of steroids by the backstage boys, it will just be the usual oozing pustuled behemoth of drearily foreseeable unforeseen consequences (Mark Steyn).
We need to accept the fact that government can’t do these things. When Mitt Romney, who was CEO of Bain & Co., for gosh sakes, can’t do it in a tiny and wealthy state like MA, without making things WORSE, it’s time to fold.
The concept came from some bright and thoughtful people.
The legislation wasn’t too bad.
The administrative regulations are a living nightmare.
Most of the technocrats have never actually done anything in the real world.
rusty,
GK Chesterton’s famously overused, attributed quote about post-religious societies believing anything is usually applied to things such as homeopathy and astrology. But I suspect a far greater number of people place an irrational faith in the power of the state.
In Market We Trust
P.S.:Not that they US Health Care Money Extraction System is in any way, shape, or form a “free market”. It is not. In any way.
Oh brave Conservative, please, beg to differ! Or else everyone here will know you were DELIBERATELY lying, rather than just being a ‘tard.
GK Chesterton’s famously overused, attributed quote about post-religious societies believing anything is usually applied to things such as homeopathy and astrology. But I suspect a far greater number of people place an irrational faith in the power of the state.
In The Free Market We Trust
Not quite the witicism the folksy Conservative wanted to here, eh?
From past experience in the insurance industry, I can tell you that getting private sector participation in any type of highly regulated insurance program is difficult. Whenever state governments introduce heavy-handed rate regulation (e.g., forcing insurers to subsidize selected market segments & overcharge others) or market conduct regulation (such as taking away the insurer’s ability to non-renew unprofitable business), many insurers will abandon the state as quickly as possible.
If the government goes a step further and sets up its own insurance program, it becomes even more difficult to get private sector involvement (speaking from personal experience as a person who works with one such program). Many insurers are opposed to the idea of participating in these types of programs for philosophical reasons. In addition, they often have better profit opportunities in other market segments.
Even for those few insurers willing to get involved in government-run insurance programs, the biggest issue is dealing with government rule making, accountability standards, and micromanagement. The rules of the game keep changing, and the insurers have no control over the situation. There’s also the very real danger that Congress may interfere. Another concern is that the program could be pulled at any time, which discourages private sector investment in the program. Participating in this type of program requires a degree of effort and intestinal fortitude that most people don’t have.
In The Free Market We Trust
Not quite the witicism the folksy Conservative wanted to here, eh?
I’m fine with that.
Yeah the Pauls are crazy. They think the government should not spend more than it takes in from taxes. They believe in the constitution. They don’t think we should go around the world bombing everybody we don’t agree with. A couple of wackos. I say we keep destroying things and running $1.5 trillion deficits. It’s the only logical thing to do.
Not as ill informed as saying healthcare is a right. Healthcare is no more of a right than owning a house.
Half the country thinks that Obama is a supernatural being because he is able to read from a teleprompter
I trust it much more than I trust Fannie, Freddie, TARP, imperialist wars, welfare plantation, banker bailouts, TSA gropers etc
Interesting concept floating around:
The ACOs could contract with existing insurers for back office and risk management models.
Sorta makes some sense, let doctors be doctors and actuaries be actuaries.
Not unanticipated at all Corev. Romney and the legislators did what many are doing nationally…avoiding conflicts with the real power centers in healthcare in MA and especially avoiding the topic of costs in the legislation.
You insist on interpreting the MA experience as an example of in general of something that fits preconceptions and somehow proves a large picture of cause and effect and ignore the reality and problems which are available.
That statement is rather meaningless ralphie.
Assuming Romney participated in a commanding way and devised a plan that addressed costs…wrong.
Dan, you made this statement: “Not unanticipated at all Corev.” but then failed to support it.
You then go on with this unsupported claim: “You insist on interpreting the MA experience as an example of in general of something that fits preconceptions and somehow proves a large picture of cause and effect and ignore the reality and problems which are available.” My example, one provided by an MD, actually is an example of cause and effect.
Was it anticipated? Was it preconceived? If so why, and if shifting care to the ER was anticipated and preconceived, did they pass the MA-care Bill to further that aim? Instead of ignoring reality, this is an example of that reality. What’s the solution un-passing MA-care?
Actually, I agree that in a constitutional sense that health care is not a “right.”
The Pauls’ ideas have not been consensus in this country, from left or right, in a long lomg time.
And I would like to see us out of Irag and Afghan.
Both want less government and both are more than willing to take a nice fat government pay check.
When we see a free market, would it be obvious?
Woulda free market evolve to Hondorus or Iceland?
Dan, we may have a difference in view point re: Ma-care. For many conservatives MA-care is the prototype for Obama-care. When we point out its warts we are also pointing out the potential for similar problems with Obama-care. If you have a different view about it not being a prototype, please explain it.
Update – as reported in Modernhealthcare.com:
Accountable care organizations will likely face start-up and first-year costs six to 14 times higher than HHS has estimated, according to a study released by the American Hospital Association.
rusty:
And neither is the Healthcare Reform Bill uncontitutional as determined by Judge Vincent and other politically biased judges. The welfare of the people as determined by the nation is a right and not to be determined by the corporacy of the healthcare industry, its doctors, and pharma, More to the point, there is no mention of corportion in the constitution and thier legalized rights.
Rusty:
Yes of course, that is the only way it could be. And what is the cost if there is no healthcare reform? Enlighten us? Could it be the AMA is afraid of any regulation to control the Rising Cost of Healthcare?
The clip is about the AHA, not the AMA.
The AHA has been a supporter of obamacare in concept, and the AMA has been lukewarm but not in serious opposition. Both recognize the need for reform.
Notice this is NOT about opposition to ACOs, this is in opposition to ACOs regs so long, complicated and onerous that operating an ACO may be impossible. See the difference?
CoRev,
Anyone who thinks that the system is performing “adequately to well” does not actually interact with the system on a regular basis.
One of my mentors, Denis Cortese used to say that it was no mere coincidence that 80% of Americans were satisfied with their healthcare coverage, when 80% of Americans had no interaction with the healthcare system in a given year outside of some minor preventative visits.
The system doesn’t work. Unfortunately, we are at a point where it will need to collapse completely. And it will. Sooner than many think.
This is not something to do with MA-Care. Here, a prominent “non-profit” clinic that is owned by a for-profit hospital just ordered it’s doctors increase their patients-per-day from around 70 to the new ‘minimum’ of 150 per day.
I do not believe anything will change significantly in any segment of the health care industry until we remove the profit motive. People wonder why costs go up? CEO pay, Shareholder Profits, Profits, Profits, Profits. When profit is a motive, they will continue to understaff, overwork and charge as much as they can eek out.
There are not many Private Practices out there – most are now Corporate Hospitals with multiple locations or Corporate conglomerates of “doctor owned” corporations.
How do you see 150 patients in a day?
Say 10 hour day = 600 minutes divided by 150 patients = 4 minutes. That assumes no breaks to go to the bathroom, eat, and instantaneous movement from room to room.
More realistic would be around 2 minutes per patient. And that’s for a 10 hour day.
I don’t see how this turns out well….
Islam will change
ilsm,
You don’t understand Paul on the issue. I agree health care is not a right. If it was then you could force a doctor to provide his services to you reguardless of your ability to pay etc. In otherwords you have a positive claim on his time and labor – which is Paul’s point about defacto slavery. Bottom line you cannot force someone to do something (in this case provide the doctor’s labor).
Think of it this was, a doctor is not required to provide his services just becuase he finds you bleeding on the sidewalk. You do not have a claim, a positive right, to the doctor doing anything but walking by or, at most, calling for help. Now the doctor could chose to help you and I would expect all to do so. But thats a voluntary decision by the doctor.
(BTW that’s why ‘good samaritan’ laws should be the nationwide standard).
I think Paul has some batty ideas and his budget will never be passed, but on this subject he’s correct.
Islam will change
I don’t know of any setting anywhere in which a doc could see 150 patients a day, not even on-call residents bouncing around answering questions from nurses.
What was the name of that hospital?