Tag: accountable care organizations

The Unlikelihood of Sustainable Growth Rate Reform this Year

Ken Perez
Ken Perez

In mid-September, the Congressional Budget Office (CBO) estimated that the cost of H.R. 2810, a permanent Sustainable Growth Rate (SGR) repeal or “doc fix,” would be $175.5 billion from 2014 through 2023, up from the CBO’s estimates of $139.1 billion in May and $138 billion in February for freezing (i.e., holding flat) all Medicare physician rates for 10 years.

H.R. 2810 would be more costly, as it does not freeze rates, it raises them slightly. As with all other SGR reform bills, its implementation would avoid an estimated 24.4 percent reduction to Medicare physician payment rates that is scheduled to take effect Jan. 1, 2014, but the bill would also increase payment rates by 0.5 percent per year during 2014-2018. That change would increase federal spending by $63.5 billion through 2018, relative to the spending projection under the SGR.

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The Reasons for and Benefits of an ACO

Wondering why ACO’s are necessary has become somewhat of a routine task, but there’s really very little question about the validity of the concept in that is does put the patient first. As we know, the goal of an ACO is to achieve cost and quality improvements, and a better approach to coordinated care on all levels.

There’s no doubt the majority of the responsibility for a successful implementation of an ACO lies with physicians. If adopted as a model, physicians are forced to lead us forward; however, the details depicted in the image below (thanks to Healthcare IT Connect for compiling it) tell a much broader and deeper story that clearly paints a picture of troubling times ahead unless something is done about this trend.

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Healthcare Technology Has a Long Way to Go Before We Can Begin Serious Conversations About ACOs

Dr. Akram Boutros

Healthcare reform was ignited by ARRA, which became the catalyst for much of the changes currently taking place in the health IT landscape, and though meaningful use is profoundly changing the way data is collected, according to some we’re a very long way away from actually being able to do something specific and positive with it.

Everyone in the healthcare community is focusing on regulation and meeting the mandates of the reform, from a healthcare technology perspective. Things get a little lopsided when the discussion turns to how the information gathered in meaningful use relates to clinical outcomes.

According to Dr. Akram Boutrous, who leads the consultancy BusinessFirst Healthcare Solutions, right now there is simply no way of collecting all of the data available in the healthcare community on a global level.

As far as he and others are concerned, under the current healthcare reform model there’s too much attention being placed on healthcare technology, including electronic health records, when there is still a mighty void between the tools used to gather the data and the tools (which don’t yet exist, he says) used to analyze the data.

“There are still many tools required to predict what is most likely going to happen in a given scenario and the best course of action to take,” Boutrous said.

He describes the current health IT landscape like an iPad without apps to use on it. “You can look at it, but you can’t do anything with it.”

This means we’re back where we have always been – in a land of silos where the information they contain stays contained without any real chance of it going anywhere to do any good.

Without interoperable systems that can communicate on a much larger scale, there’s certainly no room for even discussing the advancement of the ACO concept. “I’m pessimistic that ACOs as defined [in health IT] will provide meaningful change in healthcare,” he said.

The catalyst for change, he thinks, is the payer community and non-government organizations. Even though the federal government set the foundation for health reform, it won’t be able to maintain a successful program, and innovation will fall by the wayside.

“The non-government side of the world has taken the bull by the horns and made some very innovative advancements,” he said, while the public sector sought clarification of the reform mandates through court and legislative actions.

Until better tools can be implemented and adopted, and a culture change embraced, we’re simply not going to see models like ACOs develop according to the timeline many industry “experts” claim.

Until there are actual tools that provide meaningful support to the community and allow for some sort of global analyzing of specific populations and data sets in real time, healthcare will remain a production-based market where accountable care remains nothing more than an idea.

The market needs more than static components and databases, and health IT needs to evolve and incorporate more capabilities to that make possible, and engage in information exchange before we can begin to move to an accountable care model.