Well, gosh, this was buried on the Washington Post website and exiled over to page six in the print edition today, so I figured I’d unearth it, wipe off the dirt, and show it to you.
One of President Obama’s key selling planks for the $1 trillion Obamacare health system revamp is that it’s going to help cut the cost of providing health care. And one of the major ways he plans to cut costs is through Accountable Care Organizations, or ACOs.
Under the law, ACOs will start to become part of Medicare starting this January.
The idea of an ACO is that hospitals and doctors will band together into a kind of large unit to provide the best and most “efficient” care. If they obey certain standards of care and are able to achieve cost savings, ACO members will reap financial rewards, gaining a share of the savings. Which means your doctor will be answering to a Higher Authority.
No, not God, but possibly people who think they are. These people are often known as bureaucrats.
Doctors and hospitals will be incentivized to cut costs – “Hmm, let’s wait on an MRI. Why don’t we try some Tylenol first?” – and forced adhere to specific guidelines of care or be punished.
And who will set the guidelines for care? Big Brother, of course. According to the law:
The Secretary of HHS is required to determine appropriate measures to assess the quality of care furnished by the ACO, such as measures of clinical processes and outcomes; patient and, where practicable, caregiver experience of care; and utilization (such as rates of hospital admissions for ambulatory care sensitive conditions) . . . a participating ACO is eligible to receive payment for shared savings if the ACO meets the quality performance standards established by the Secretary of HHS and the ACO meets the saving requirement . . .
Phew. Sounds like a lot of paperwork and oversight. I hope your doctor doesn’t turn out to be some kind of individualist.
In the study written up by the Washington Post, ten health systems from around the country formed an ACO and were followed for five years. Not much money got saved, even though the groups participating were long-established players and were subject to less stringent rules than those participating under the health law must submit to.
From the article:
Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush, said . . . it is “astounding” that savings were not greater among 10 long-established groups that she said “should have blown it out of the water. . . . It’s like, are you kidding me? . . . If it was this tough for this group that I had just assumed would be hands-down winners, what does it say for groups that don’t have a long history of coming together?”
The experiment, she and other health policy experts point out, was less risky financially for the groups than the proposed ACO rules, because the participants were not penalized for overspending.
Well, let’s try it anyway. That effectively was the quote from Medicare administrator Donald Berwick, who, you may remember, was never confirmed by Congress but rules his kingdom nevertheless.