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On ACO Business Model Savings?

4 Responses

1. Grant, on August 21, 2014 at 11:39 AM said:

   Think ACOs and Bundled Payments are Inevitable?

   http://diseasemanagementcareblog.blogspot.com/2014/08/think-bundled-payment-is-inevitable.html

   Well, think again!

   Grant

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2. Ann Miller RN MHA, on October 22, 2014 at 1:19 PM said:

   The relationship between consolidation and prices

   According to Aaron Carroll MD, over at the Incidental Economist, one of the biggest concerns about ACOs is that the push towards provider consolidation may lead to increased spending that might overwhelm the savings they’re supposed to generate.

   A just-published paper in JAMA is on point. “Physician Practice Competition and Prices Paid by Private Insurers for Office Visits“:

   He reiterates the following points:

   IMPORTANCE Physician practice consolidation could promote higher-quality care but may also create greater economic market power that could lead to higher prices for physician services.

   OBJECTIVE To assess the relationship between physician competition and prices paid by private preferred provider organizations (PPOs) for 10 types of office visits in 10 prominent specialties.

   DESIGN AND SETTING Retrospective study in 1058 US counties in urbanized areas, representing all 50 states, examining the relationship between measured physician competition and prices paid for office visits in 2010 and the relationship between changes in competition and prices between 2003 and 2010, using regression analysis to control for possible confounding factors.

   EXPOSURES Variation in the mean Hirschman-Herfindahl Index (HHI) of physician practices within a county by specialty (HHIs range from 0, representing maximally competitive markets, to 10 000 in markets served by a single [monopoly] practice).

   MAIN OUTCOMES AND MEASURES Mean price paid by county to physicians in each specialty by private PPOs for intermediate office visits with established patients (Current Procedural Terminology [CPT] code 99213) and a price index measuring the county-weighted mean price for 10 types of office visits with new and established patients (CPT codes 99201-99205, 99211-99215) relative to national mean prices.

   http://theincidentaleconomist.com/wordpress/the-relationship-between-consolidation-and-prices/

   Ann Miller RN MHA

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3. Hope R. Hetico RN MHA, on November 5, 2014 at 12:32 AM said:

   ACOs Are Doomed / No They’re Not

   A number of pundits are citing the systemic failure of ACOs, after additional Pioneer ACOs announced withdrawal from the program – Where do you weigh in on the prognosis for Medicare and Commercial ACOs over the next several years?”

   Please opine.

   Hope R. Hetico RN MHA

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4. Dr. David Edward Marcinko MBA, on April 9, 2015 at 5:33 PM said:

   Global Physician “Capitation” Payments Making a Comeback

   Since passage of the PP-ACA many insurance carriers are making a major change in the way they pay physicians? It’s moving from [discounted] fee-for-service pay to per-patient per-year capitation rates, adjusted for age and sickness (severity adjustments), plus a bonus for those MDs who improve patient health status. No definition of this term was given; however. Under the new “incentive” plan, these plans hope to transfer risk to primary medical care groups.

   Typically, capitation will cover all primary care, specialist, counselor and hospital costs. Interestingly, BCBS has publicly denied that this system is “capitation”, and assured the public that it has safeguards in place to make sure patients won’t be under-treated and doctors won’t be underpaid.

   Yet, BCBS for the State of Massachusetts hopes to cut the growth in medical costs in half in two to four years among providers who accept this cloaked global capitation-redux.

   Dr. David Edward Marcinko MBA

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