Tag Archives: Payment Reform

It’s the Price, Stupid! Or Not!

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Happy Haloween

Happy Halloween

It’s the Price Stupid is the title of a seminal paper in Health Affairs that concluded that the United States pays more for health care and receives less than in other developed countries.

It is also a theme resurrected by Alec MacGillis in a Washington Post article last week.

The argument goes like this.   The United States pays more for health care than anywhere else on the planet, as much as 50% more than the average for other developed countries.

Yet we get fewer services;  fewer physician visits, fewer hospital admissions, fewer days in the hospitals.     It doesn’t take a Ph.D. statistician to conclude that we are paying too much per unit of care.

But does health care reform fix it?

To MacGillis cost controls means price control. Continue reading →

Socialized Medicine – an Evolutionary Approach

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Accountable care organizations.  Patient centered medical homes.  Episodes of care.

What do they have in common?

They each attempt to use payment incentives to encourage disparate practitioners to collaborate to achieve quality outcomes.

A common purpose

A common purpose

Socialized medicine is progress

The key word is collaborate.  Countless research indicates that when doctors work in teams, they achieve better results at lower costs.  It is this transition from doctor as solo practitioner to doctor as a member of a team that is the key challenge to reforming our health care delivery system.

This transition from solo craftsman to a member of a team is not new to the evolution of our economy.

It is how Karl Marx differentiated capitalism from the mercantilist economy that preceded it.  He called it the socialization of work.  It was this contradiction between the socialization of work and the private ownership of the means of production – capital –that was supposed to be resolved by the socialist revolution.

Karl Marx recognized that this socialization of work brought tremendous increases in productivity to the world economy. Continue reading →

Episodes of Care – A Baby Step

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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 →