The Intermittent Kevin

As rarely and randomly updated as most blogs

Accountable-care organizations in the HCR bill

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Real quick followup to my previous post: I poked around and discovered that, indeed, the HCR bill includes some promising provisions for expanding the use of accountable-care organizations (ACOs) like you see at the Mayo Clinic and in other communities.

I actually took a crack at reading the bill itself, which is incredibly dense in some places but pretty straight-forward here. To wit:

Section 3022, page 739: By 2012, the government will establish a program to reward ACOs via “shared savings.” What this means: if you’re a doctor in an ACO, and your org manages to save money to Medicare while maintaining certain quality standards, then you get a cut of the savings back to you. Kinda like a Discover card rebate. …Or not.

ACOs can be hospitals, clinics, groups of independent doctors, or even a combination. The group signs on for a minimum of 3 years, needs to be responsible for at least 5,000 Medicare patients, and manages its own organization and pay structure.

The quality-of-care metrics are the primary way that the fed will be sure the group isn’t skimping on necessary treatment to save money. (There’s also a provision to make sure that doctors don’t skip on treating risky or expensive patients just to pad their rebate check later on.)

Section 3022, page 739: A very similar program will be enacted for groups of pediatricians to receive “incentive payments” (also a portion of the savings produced) for producing similar cost-of-care improvements among the kiddos. (This time the savings are measured by billings to Medicaid and CHIP, if you care.)

Absolutely there’s still opportunity for fraudulent use of the system that puts the needs of patients on the back burner. But, going back to my previous post, ACOs almost by definition pay doctors less money. So any doctor that voluntarily joins the ACO is probably not looking to make the big bucks first and foremost. Plus, these are all just pilot programs (and the HCR bill includes many more) to see what works, so it can hopefully be expanded further in the future.

As I indicated in my previous post (and back in September), saving money isn’t just a perk of health-care reform; it’s an essential piece of it. The good news is that there is plenty of waste to be attacked, and plenty of great ideas about how to do it. So these ACO incentive programs are a step in the very right direction.

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Written by Kevin Miller

March 28, 2010 at 6:59 pm

Posted in Uncategorized

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