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Defining the Accountable [Health] Care Organization

24 Responses

1. Barbara, on October 16, 2010 at 11:33 AM said:

   More on ACOs

   Excellent post, above. Now, here is a related article from Health Policy and Reform:

   http://healthpolicyandreform.nejm.org/?p=12750&query=TOC

   Barbara

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2. Dr. David Edward Marcinko MBA, on November 2, 2010 at 10:17 AM said:

   ACOs and the Shared-Savings Sham?

   In a recent American Journal of Managed Care commentary, Shared Savings Program for Accountable Care Organizations [A Bridge to Nowhere?], Bob Berenson described how the ACO concept can fail to achieve the savings and quality goals it presumably would promote.

   http://www.ajmc.com/issue/managed-care/2010/2010-10-vol16-n10/AJMC_10oct_Berenson_721to726

   Your thoughts are appreciated.

   Dr. David Edward Marcinko MBA
   [Publisher-in-Chief]

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3. Jimmy, on December 7, 2010 at 11:35 AM said:

   Flawed ACOs?

   Some believe that ACO models offer nothing that other ASOs -alphabet soup organizations -have not offered in the past. HMOs, PPOs, MCOs and more have all been tried and if not failed, at least have never lived up to the hype.

   http://www.hospitalimpact.org/index.php/2010/12/01/aco_s_are_based_on_flawed_assumptions?utm_medium=nl&utm_source=internal

   There is no reason to believe ACOs will fare any better. But, it’s possible the ACO experiment will be more dangerous than its proponents care to admit.

   Jimmy

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4. Hope, on December 22, 2010 at 1:27 PM said:

   New PHOs Are Being Structured as Stepping Stones to ACOs

   A growing number of hospitals are turning to physician-hospital organizations (PHOs), a model from the 1990s that these hospitals say will prepare them for certification as accountable care organizations (ACOs). Among the structural and operational elements that differentiate these PHOs from their predecessors are full transparency, strong physician leadership, and organizational structures that enable them to operate as independent legal entities in which risks — and rewards — are shared equitably.

   Many of the new pre-ACO PHOs operate as limited liability companies (LLCs) with operating agreements that ensure that the investment risk is equally divided between physicians and hospitals, and that all contracting and payment mechanisms are fully transparent to members. “These PHOs typically are controlled equally by the physicians and the hospital,” says John Harris of DGA Partners, a healthcare management consulting firm, although in some cases physicians hold majority voting power.

   Source: Michael E. Carbine, ACO Business News [12/17/10]

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5. Limon, on January 6, 2011 at 11:31 AM said:

   Patient Centered Care – Almost?

   Patients still don’t know enough about the care they receive. That’s one major finding from a recent survey by the Schwartz Center for Compassionate Healthcare.

   http://www.hospitalimpact.org/index.php/2010/12/13/patients_often_are_left_out_of_the_patie?utm_medium=nl&utm_source=internal

   Limon

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6. D. Kellus Pruitt DDS, on January 27, 2011 at 2:45 PM said:

   Holding DentalPlans accountable to dental patients

   Recently, I got into a discussion with an anonymous DentalPlans sales rep that goes by the name “Dental Hygenie.” We were discussing the morality of deceptive advertising in the discount dentistry market and gullible, vulnerable dental patients. I’m hoping she’ll return to fasten down some loose ends. I’m pretty sure Hygenie is a woman.

   “We don’t have our own dentists. We simply provide consumers with a list of dentists that accept dental plans. We are always researching and getting feedback. Thanks for all your questions. Darrell, it’s been fun chatting with you today!”

   ————–

   My reply:

   I’m sorry you had to rush off, Dental Hygenie. I’ve sincerely enjoyed our conversation and learned a lot about DentalPlans from you. I hope that the information we shared will help others understand their choice in dentists – including discount dentists promoted by DentalPlans who work for as little as 15% of their normal salary (A 30% discount based on an industry average of 65% overhead means a 5% net, versus a dentist’s full pay of 35% net).

   To clarify one of your statements, I should point out that you also wrote that DentalPlans dentists offer discounts as high as 60%. I think that quote must have been a typo. Anyone can see that if a dental practice has a 65% overhead, and sells dentistry at a 60% discount, the dentist would make more money by staying home.

   For example, if one nets a negative 25% on each widget one sells, making more widgets will only dig one deeper in debt. You really didn’t mean to advertise that DentalPlans offers 60% discounts, did you, Dental Hygenie? That would be misleading and probably illegal outside the Internet. Such deception certainly wouldn’t be ethical.

   Even a 30% discount simply sounds incredible. As a dentist, I cannot imagine working 7 times faster to make the same amount of money I earn now, and still maintain the quality my patients expect of me. Dentistry is intricate, one-of-a-kind handwork performed to tight tolerances in juicy, wriggly mouths attached to occasionally nervous patients who sometimes show up late, or not at all. Please help me and others understand how dentists can discount their work by 85% and not go bankrupt.

   I find another of your statements confusing. It may be a typo as well. You said, “You pay a one time fee starting at $79 for the year and start to receive your discounts almost immediately.” Did you mean to say there is a one time fee or a yearly fee starting at $79?

   I’m hoping you will find time to return soon. I have other questions your potential customers would ask if they had a clue where to start. I’d like to discuss more about DentalPlans’ quality control with you. I’m glad to read that DentalPlans’ business partners like Aetna and BCBS scrutinize the dentists they send trusting and vulnerable patients to see. After all, to offer dentistry by the lowest bidders with no quality control would be morally bankrupt.

   Whatever your name is, you just have to agree that since most people are clueless about dentistry, they are terribly vulnerable to being ripped off by anonymous salespeople. Let’s you and I make sure it doesn’t happen on Dental Facebook.

   D. Kellus Pruitt DDS

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7. D. Kellus Pruitt DDS, on January 29, 2011 at 10:01 PM said:

   I Want a DentalPlans Supervisor
   [And, I hear what you’re saying!]

   Dental Hygenie might have escaped my grasp, but not cleanly. The anonymous DentalPlans sales rep may have to pick a new avatar before I’m through. No big deal, Internet aliases are cheap. In my latest post on Dental Facebook, I told Dental Hygenie that I want to speak with her boss at DentalPlans.

   Also today, Reuters coincidentally posted an article titled, “WikiLeaks founder says enjoys making banks squirm.”

   ——————————-

   Dental Hygenie, I just noticed that it’s been 3 days and you haven’t offered a response about DentalPlans’ quality control measures. I re-read my final paragraph from our conversation on Wednesday and realize now that honesty about rushed, discounted handwork might have scared you off. I really didn’t intend to do that. I think I speak for most of us here on Dental Facebook when I happily invite you, or preferably your supervisor at DentalPlans, to come out into the Community and level with those of us whom DentalPlans’ deceptions are likely to hurt.

   Considering the way I rudely blindsided you – as if you could shoulder responsibility for DentalPlans – I certainly don’t expect you to find returning to this venue easy to do. But what do you have to lose, Dental Hygenie? Since you’ve maintained anonymity so far, you haven’t yet made a public investment in DentalPlans and therefore cannot be held personally accountable for any mistakes you might have already made in misrepresenting your boss’ interests. You’re covered. Besides, it’s not you I want to talk to anyway.

   If your boss doesn’t want to be bothered by discussing DentalPlans dental benefit policies with dentists and patients DentalPlans executives need like oxygen, at least let her know that our conversation turned out to be fairly popular in the Community and was quickly picked up by at least two industry Websites.

   Thursday, the day following our conversation, the Medical Executive-Post published “Holding DentalPlans accountable to dental patients”

   Defining the Accountable [Health] Care Organization

   Then just yesterday, RiskManagers.us posted our discussion about quality as “Discount Dentistry – A Dentist’s Perspective.”

   http://blog.riskmanagers.us/?p=5107

   Here’s a level of quality that I suggest DentalPlans aspire to: RiskMangers.us, is an insurance company I’ve known about for years that competes with DentalPlans in the dental benefits industry. Yet unlike DentalPLans, transparency has never intimidated officials of RiskManagers because they have nothing to hide from their customers whom they serve with respect.

   Now that I’ve given it more thought, please get me in touch with your supervisor, Dental Hygenie. If not, can you at least slip us her name and email address? I have even more questions for her and I don’t care how they’re delivered.

   D. Kellus Pruitt DDS

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8. Dr. Pruitt, on January 30, 2011 at 5:30 PM said:

   Happy hunting, sports fans

   You want “professionalism” or do you want to move the parasites out of our neighborhood?

   I think those following my frank marketplace conversation with a rookie DentalPlans representative will attest to such conversations’ potential benefit in the dental community, even though pious loyalists with nice teeth who think “Image is everything” still deride this dentist’s behavior as “unprofessional.” For one thing, I don’t think we’ll be hearing any more DentalPlans lies around here. That’s something, isn’t it?

   Since Internet transparency in the dental marketplace makes it uncomfortable for salespeople like Dental Hygenie to even anonymously trot out deceptive advertisements, simple questions about claims that sound too good to be true will not only decrease the cost of dental care in the nation, but will improve the quality by eliminating unnecessary root canals, fillings and crowns performed much too quickly. It’s actually the Hippocratic thing to do. Again, that’s something.

   Interested yet?

   Before locking onto your own slow-moving dinosaur, I should caution that frank marketplace conversations have gotten me kicked off numerous commercial Websites and Facebooks. You shouldn’t commit anything you’re not willing to lose.

   We’ve got these two advantages: 1. Discount dentistry brokers like DentalPlans sell dentistry by the lowest bidders with no quality control and 2. Nobody respects anonymous salespeople.

   D. Kellus Pruitt DDS

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9. Mary, on January 31, 2011 at 12:46 AM said:

   ACOs

   Darrell – Another definition was posted on the ME-P right here:

   Defining the Accountable [Health] Care Organization

   Mary

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10. Hope R. Hetico RN MHA, on January 31, 2011 at 11:13 AM said:

    ACOs and Pete Stasrk

    The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 introduced many changes to the US healthcare delivery system, including initiatives regarding the development of Accountable Care Organizations (ACOs).

    Given the collaborative and integrated structure of ACO arrangements, questions have arisen related to the legal permissibility of these arrangements under the Stark Law.

    Click to access aco.pdf

    Hope R. Hetico RN MHA
    http://www.BusinessofMedicalPractice.com
    [Managing Editor]

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11. Darrell, on January 31, 2011 at 10:20 PM said:

    Hold me accountable. Please.

    Unlike those who evade my questions and call it “professionalism,” I welcome thoughtful criticism and promise thoughtful responses. I’m very confident where I stand, and am rarely challenged. Yesterday, I emailed “HIT hits reality” to a long-term friend in the HIT business whom I respect, just to read his reaction. My repeated blunt criticism of the purpose of his career would make a lesser HIT stakeholder lash out defensively and in anger – if at all – instead of extending a hand in friendly discussion. I wish our shy leaders in dentistry were more like John.

    John’s comment:

    Interesting summary.

    I guess my only thoughts as I read this and the other things you wrote is that your tone comes off as a bitter doctor that’s just angry about it all. Which could be pretty accurate. The problem is that you lose credibility with readers when they think that your motivation is that you’re bitter as opposed to just someone with their head on straight commentating on something that could have tremendous impact.

    A lot more trust is gained by a reader when you come off as someone who cares about healthcare, cares about patient care and cares about the future government spending and is concerned about the direction things are going. Otherwise, bitter doctor just sounds like someone who is trying to protect themselves, their paycheck, their lifestyle, etc to many.

    Plus, it’s certainly one thing to be critical, but I haven’t seen you offer any solutions to the problems either. Or I haven’t heard you suggest why the status quo would be better than these alternatives people are proposing. Critical without solutions or suggestions helps to reinforce someone who just likes to complain instead of someone who really cares about what’s happening.

    Of course, you might not even care. Doesn’t bother me at all either. I just think a slight change in your approach could have a far greater impact while still espousing the same core principles.

    John
    ———–

    My response:

    I sincerely appreciate your honesty John, and will forever take your advice into consideration as I continue my struggle against absurdities in healthcare. But now that I’ve had a chance to think about it, I’m pretty sure you don’t know where I’m coming from.

    I honestly and respectfully think your advice might have been more appropriate had you been giving it to someone other than me, and you are 5 years too late. In spite of your optimism about how neatly the marketplace works, I learned on my own that tact always sucks when delivering politically-incorrect truth. Nobody wants to hear bad news again and again no matter how politely it’s delivered. Fortunately for my ego, I don’t seek authentication from large numbers of fans. It’s enough for me to know that my messages are reliably impacting their targets.

    Like always, you put a lot of thought into your note. I’m touched by your concern for me as a person. That is so rare to see on the internet. But I’ve known for a while that you aren’t like other HIT stakeholders I’ve met. You attract the best in others because anyone can read in the words you choose that you are one of the few who sincerely care.

    When you say I appear to be bitter, you are partially correct. On the Internet, I’m indeed a bitter provider, but I’m hardly a bitter dentist. There is no career I could have chosen that better fits my interests and talents. It’s not hard to tell that my patients love me as much as I love them. Since very few have a clue about my Internet alter-ego (some have said they approve), this is sort of like a hobby, actually.

    It’s the ambitious healthcare parasites who promote mandates to raise the cost of treatment while offering patients no improvement in care that I viscerally despise. It hurts a little that I come across as a bitter person, but then it has never been my intention to be popular anyway. I sort of like being abrasive, actually. As for credibility, you’ll just have to trust me when I tell you I have no credibility problems with unresponsive targets of my messages. And as for others who are interested in watching transparency happen in a distasteful way perhaps, I never turn anyone away.

    But yes. I’m bitter for natural reasons.

    Insurers caused my bitterness to quietly simmer for about a decade or so concerning ever-increasing interference in my relationships with patients who put their trust in me. Then in 2006, I began expressing my opinions about very bad ideas in dentistry according to accepted rules of dissent – mostly involving HIPAA, by the way. The more the good ol’ boys evaded my sincere and cogent questions about things like patient privacy and the NPI number, the harder I pushed for answers. Eventually, it was my determination to uncover the truth about how eHRs affect dentistry that got me kicked out of the Texas Dental Association. So do I have reason to be bitter, John?

    I get even. The targets of my messages in the ADA will inevitably have to admit what I told them 5 years ago: Electronic dental records unnecessarily endanger dental patients, do not improve dental care and cost more than they save. Have you ever seen a bitter person say, “I told you so”?

    Like you, I also once believed in the magic of “constructive criticism:” It is important not to just tear something down, but to offer an alternative solution. That was our rookie mistake, John. For years, I repeatedly invited ADA officials to discuss de-identification of dental records which would make them even safer than cloud computing. It made no difference at all how my suggestion was presented. Nobody wanted to hear it, much less discuss it. Face it. You’re seeing it yourself for physicians as we speak. Until dental care IT stakeholders’ bad plans publicly crash, nobody is going to listen to the dentists who actually treat patients with their lousy products that won’t sell without subsidies and threats. I’m already in a perfect position to say I told you so.

    If it looks to others like I’m trying to protect myself, my paycheck and my lifestyle, I am. If patients depended on you staying in business, wouldn’t you also do your best to survive? Dentists are an exceptionally quiet bunch. Many are hurting badly. Other than me, nobody is fighting for them. What’s bad for dentists is worse for dental patients. That’s just the way it is, like it or not.

    Thanks for this opportunity to define myself. Every now and then, we all must reassess what we stand for.

    Darrell

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12. Hope R. Hetico RN MHA, on February 1, 2011 at 9:40 PM said:

    Impact of the ACA on Hospitals

    Since the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, reform initiatives have already begun impacting many healthcare providers, including hospitals.

    This article by Health Capital Consultants LLC highlights a few of the key provisions impacting hospital providers and the resulting impact on the healthcare delivery system as a whole.

    Click to access aca.pdf

    Hope R. Hetico RN MHA
    http://www.BusinessofMedicalPractice.com
    [Managing Editor]

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13. Mark, on February 8, 2011 at 11:36 PM said:

    ACOs – Too Expensive?

    Before embracing an accountable care organization model, academic medical centers need to assess the financial risk, according to the New England Journal of Medicine.

    http://www.healthcarefinancenews.com/news/nejm-article-spotlights-financial-risks-associated-acos

    Mark

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14. Bradley, on February 21, 2011 at 10:19 PM said:

    Will ACOs End Innovation?

    In his latest Health Policy Outlook, Dr. Scott Gottlieb takes a look at accountable care organizations (ACOs) which are being touted by the Obama administration as a cost-cutting option and a key part of health care reform.

    http://www.physiciansnews.com/2011/02/18/accountable-care-organizations-the-end-of-innovation-in-medicine/

    Gottlieb states that “the prospect that hospitals will soon own a majority of medical practices in the United States is already worrying some doctors and policymakers.”

    What do you think?

    Bradley

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15. Ann Miller RN MHA, on March 15, 2011 at 12:09 PM said:

    Primary-Care Group Launches Center for Accountable Care

    The Patient-Centered Primary Care Collaborative, a coalition of some 700 employers, consumer groups, and primary-care organizations, has formed the Center for Accountable Care in an effort to ensure that “a strong, robust patient-centered primary-care model is at the foundation of accountable care organizations.

    Among its activities, the center will identify and share best practices related to medical-home-based ACOs and educate federal and state government officials, media members, and consumer organizations about the center’s policy recommendations and advocate for those policies, according to a news release from the collaborative.

    Source: Modern Physician [3/14/11]

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16. Dr. Markus O'Hare, on March 17, 2011 at 8:25 PM said:

    ACO and Cost Controls

    There is nothing inherent in the current marketplace that would cause an ACO based global payment system to contain health care costs; IMHO. In fact, it may/will be inflationary.

    Dr. Markus O’Hare

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17. Hope Hetico RN MHA, on April 1, 2011 at 10:14 AM said:

    CMS Issues Proposed ACO Regulation

    HHS has issued its proposed regulation on accountable care organizations (ACOs), the new delivery and payment model the agency estimates could serve up to 5 million Medicare beneficiaries through participating providers, and also potentially save the Medicare program as much as $960 million over three years.

    An ACO is a group of providers and suppliers of healthcare services who work together to coordinate care for patients they serve with “original” Medicare, or those who are not in Medicare Advantage private plans. Under the rule, the CMS would continue to pay individual healthcare providers and suppliers as it does under Medicare, and also develop a benchmark for each ACO against which its performance is measured to determine if the ACO qualifies to receive shared savings or be held accountable for losses.

    Source: Rich Daly and Jessica Zigmond, Modern Healthcare [3/31/11]

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18. Ann Miller RN MHA, on April 4, 2011 at 11:01 AM said:

    ACO Privacy Rules Proposal

    Click to access 2011-07880_PI.pdf

    Ann Miller RN MHA
    [Executive-Director]

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19. Darrell, on April 4, 2011 at 7:03 PM said:

    Accountable Care Organizations

    Today, Jeffrey L. Cohen, who provides legal counsel for the Florida Medical Association, posted an informative and easy to read article describing the essentials of Accountable Care Organizations on KevinMD.com.

    http://www.kevinmd.com/blog/2011/04/aco-regulations-accountable-care-organization-answers.html

    Darrell

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20. Jane, on April 8, 2011 at 12:40 AM said:

    Why ACOs Won’t Work?

    There is a problem with ACOs: They are a tool in a big tool box of care and cost management tools but, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.

    http://thehealthcareblog.com/

    What do you think?

    Jane

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21. Ann Miller RN MHA, on April 8, 2011 at 3:49 PM said:

    Docs, CMS in Talks to Extend PGP Demo

    Ten physician group practices are negotiating with the CMS to continue for two years the Medicare payment experiment widely cited as the forerunner to accountable care organizations (ACOs), according to medical group executives. The Physician Group Practice Demonstration, which ended in March 2010 after five years, offered bonuses tied to quality performance and cost control for Medicare fee-for-service patients. Financial returns for physician were mixed during the first four years, and no data is yet available for the final year.

    Under the two-year extension, financial incentives would be changed to more closely fit proposed rules for Medicare ACOs released last week, said David Spahlinger, executive director of the University of Michigan Medical Group Practice, one of the 10 physician groups included in the original demonstration. That would allow Medicare to test incentives ahead of the 2012 launch of Medicare ACOs and help physician groups to prepare for accountable-care efforts, he said.

    Source: Melanie Evans, Modern Healthcare [4/7/11]

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22. Donna, on June 1, 2011 at 8:09 PM said:

    As Details Emerge, ACO Excitement Wanes

    http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=8300002256

    Now, why am I NOT surprised.

    Donna

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23. Bradley, on June 2, 2011 at 7:14 PM said:

    Experiment to lower Medicare costs did not save much money

    http://www.washingtonpost.com/national/experiment-to-lower-medicare-costs-did-not-save-much-money/2011/05/27/AG9wSnGH_print.html

    ACOs no “magic bullet.”

    Bradley

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24. Ann Miller RN MHA, on August 30, 2011 at 10:01 AM said:

    Survey Finds ACOs Loosely Defined But Growing

    Accountable care organizations, a fashionable name for a loosely defined fix for U.S. healthcare, are the center of debate, gossip, and conjecture among policymakers and healthcare leaders.

    But, the murky state of the model and poorly received draft regulations intended to clarify the sketch included in the healthcare reform law have not deterred plans among some hospitals, medical groups, and payers to make accountable care something real, rather than mere aspiration.

    Indeed, the results of Modern Healthcare’s first survey of accountable care organizations provide a snapshot of 13 accountable care organizations that executives say could reduce medical errors and waste with financial incentives for quality and lower costs. They include everything from fledgling alliances to detailed agreements.

    Some already track quality and spending under contracts with commercial insurers. Others have yet to complete physician arrangements. A few have poured capital into ancillary businesses.

    Source: Melanie Evans, Modern Healthcare [8/29/11]

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