Monthly Archive for May, 2010

Episodes of Care – A Baby Step

May 29, 2010
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There is broad consensus that fee for service medicine as practiced the United States is not cost effective nor does it produce good health outcomes.

There is also broad consensus that the oil spewing out of a failed wellhead 5,000 feet under the surface of the Gulf of Mexico is not a good thing.

Fixing either one is not easy or quick.

Bundled, now what?

Bundled, now what?

The Patient Protection and Affordable Care Act (PPACA) recognizes the problem and proposes a variety of strategies to promote some of the ideas already in play.  I wrote about two of those strategies recently, accountable care organizations and patient centered medical homes.

Episodes of care as hybrid

If there were a continuum leading away from fee for service reimbursement toward a global payment methodology, then the accountable care organization is furthest removed from fee for service reimbursement .  The patient centered medical home brings us closer to fee for service only because it does not encompass inpatient hospital care. Continue reading ‘Episodes of Care – A Baby Step’

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Government boasts $2.5 billion Medicare fraud recovery, assures health reform will up success – FierceHealthcare

May 24, 2010
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By Debra Beaulieu

The government recovered $2.5 billion in overpayments for the Medicare trust fund last year–up from $1.9 billion in 2008–and says that the stepped-up antifraud measures in health reform will ensure even greater future success.

As Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder pointed out during yesterday’s news conference, the newly enacted Affordable Care Act provides an additional $300 million over the next 10 years to fight health fraud, enhances the government’s oversight of companies participating in Medicare and Medicaid and lengthens prison sentences in criminal cases.

Government boasts $2.5 billion Medicare fraud recovery, assures health reform will up success – FierceHealthcare

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Medical Home – Patient Centered Care

May 22, 2010
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The term medical home prompts associations with George Carlin and his comparison of baseball and football.

In baseball the object is to go home! And to be safe! – I hope I’ll be safe at home!

In football, we’re down in enemy territory

Reaching for the end zone

What would George offer as the medical counterpoint to “home”?  End zone might be a bit extreme.  But “homeless” could surely fit.

Can health care reform offer help for the medically homeless?

Safe at home

Safe at home

Medical home demonstration projectts

Shortly after the Patient Protection and Affordable Care Act was passed in March of this year, Mr. Vince Kuraitis, writing for the e-caremangement blog noted that the word “pilot” appears 80 times in the law, and the word “demonstration” is used 312 times

He might have also noticed that the term “medical home” appears 11 times,  exactly the same as “accountable care organization” that I discussed last week. Continue reading ‘Medical Home – Patient Centered Care’

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Health Care Reform, Patient Protection and Affordable Care Act (PPACA) and Payment Reform-- Tags: , , .

Accountable Care Organizations – a Primer

May 16, 2010
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There is much in the Patient Protection and Affordable Care Act (PPACA) that is good.  Unfortunately, most of that is barely comprehensible to the average American.

One area in particular gets kudos from health care policy wonks.  The legislation describes numerous programs designed to encourage health care delivery reform and payment reform.

In the lingo of the tea party louts these are evil “pilot programs” designed merely to sprinkle government largess to purveyors of unproven ideas.

Over the next few weeks I will examine some of those ideas. Some are specifically mentioned in PPACA and others are models that hope to gain some traction from the law.

Accountable Care Organization

I want to start with accountable care organizations.  Not because the concept has any special appeal or primacy.  I simply like the name. Continue reading ‘Accountable Care Organizations – a Primer’

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The Next Bailout? Employer Health Care

May 9, 2010
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Will health care reform support or undermine the employer-based system that provides health care coverage for the majority of working age adults?

Employer sponsored health care

Employer sponsored health care

According to a report by Fortune, several Fortune 500 employers have considered dumping the health care coverage they now offer to their employees.

Caterpillar, Deere, Verizon, AT&T, Bayer, and some other Fortune 500 companies have weighed the fines levied by the Patient Protection and Affordable Care Act (PPACA)against the cost of offering health insurance.

The fines win.  It’s cheaper to pay than to play.  Billions of dollars cheaper.

It’s not just the fines.

Fortune uncovered this story by combing through documents the companies submitted to Congress when Congress questioned the big tax write offs the companies took after after passage of PPACA.

The write offs, Congress learned, were legitimate.   Accounting rules require companies to account as a liability the future costs of retiree health care.  Those accounting rules are a big reason why the number of retirees covered by employer sponsored health insurance has dropped from over 40% to near 20% in the last twenty years. Continue reading ‘The Next Bailout? Employer Health Care’

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Employer health insurance, Health Care Reform and Patient Protection and Affordable Care Act (PPACA)-- Tags: , , , , , , , , , .
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