ACOs

Insurance companies are unlikely to have much more impact on spending growth than they’ve had for the past few decades. The real question about insurers’ role in health care is why they’ll be needed if providers can form organizations that are accountable for the cost and quality of care.

Consultant Greg Mertz feels there is a robust future for private practice, even though practice models will have to change.

A staggering 40 percent of physicians say they plan to leave patient care within the next three years, according to a recent poll by the Physicians Foundation. That spells big trouble for healthcare reform and for medicine in general. If even half of that number of doctors retire, find administrative positions, or leave healthcare entirely, we’re going to have medical assistants taking care of patients and the remaining doctors tearing out their hair in frustration.

While the ACO concept gained momentum as a result of the healthcare reform legislation, the idea is nothing new. The Clinton health initiative included similar networks of providers, Accountable Health Partnerships, a proposal that went nowhere. So why should we worry about the current ACO model?

Hospitals need not control ACOs. There are clinically integrated IPAs and PHOs that could easily become ACOs, and 50 to 75 other physician-led organizations are on the same path. Among these entities is the Beacon IPA of Manhasset, NY. Formed last summer, the IPA already has about 200 physician members, and the IPA’s long-term goal is to become clinically integrated and ready for whatever healthcare reform brings, including ACOs.

The AMA’s new policy on accountable care organizations (ACO) will undoubtedly please many physicians, but it doesn’t recognize the reality of the market or of healthcare reform. Once again, it shows how unprepared the leaders of medicine - and many of their followers - are for the massive changes that lie just ahead.

In a recent interview with Physicians Practice, American Medical Association President Cecil B. Wilson puts aside the notion that the group is no longer relevant and when asked if it still represents the majority of U.S. physicians, adds a confident "You betcha."

Doctors will continue to duke it out over reimbursement while pushing for a larger pot that will fund quality incentives. The problem is, the money available to pay physicians isn’t going to keep growing because we can’t afford to keeping paying more for healthcare. So physicians must accept the hard reality that they have hit their limit and will likely see reimbursement shrink in coming years.

Litigation can cost time, money, and even reputations for healthcare providers and their partners. At this year's MGMA annual conference, Michelle M. Skipper of the American Arbitration Association pointed out another solution: alternative dispute resolution.

Healthcare reform has passed, and many provisions are being implemented. But future milestones in the legislation are still very much up in the air. So what should you be doing now? And what will happen to the reform after the November elections? Two MGMA experts offer some guidance.

Panelists from the "Perspectives on Healthcare Reform" general session at MGMA 2010 discuss their concerns about the Affordable Care Act, accountable care organizations, and the Medicare sustained growth rate (SGR) formula.

A new Institute of Medicine report on the future of nursing - and the AMA’s response to it - has raised the doctor-nurse turf battle to a new level of acrimony. It’s time for this unproductive debate to end. Instead of talking past each other, physicians and nurses ought to recognize that medicine is entering a new era that will require an unprecedented amount of cooperation among all healthcare professionals.

A new report has discovered the "crucial element" to achieve effective, affordable care for Americans in the new world created by health reform: nurses.

We just entered the fifth month of the new, post-federal health reform world and just in case you had any concerns, the White House is here to remind you to relax, take a deep breath and get ready to change nearly everything about the way you practice medicine.In the current issue of the Annals of Internal Medicine, Nancy-Ann DeParle, director of the White House Office of Health Reform, and two medical colleagues have authored a tome on the “opportunities and challenges” presented by the Affordable Care Act , passed on March 23.

Patients must be educated about the purpose of the medical home and the need for care coordination.

As more doctors go to work for hospitals, more of their colleagues are thinking about giving up private practice. But is this the only way to go-and will it help fix the healthcare mess or make it worse?

Medicare’s shared savings approach grew out of its Physician Group Practice (PGP) demonstration. The results of the pilot for first three years were fairly impressive.

The plain fact is that Medicare accounts for a fifth of the nation’s total healthcare spending. Physicians who turn their backs on that are endangering the long-run financial health of their own practices. And, sooner or later, the government will have to fix the Medicare reimbursement formula.

In the current economic environment, physicians across the country may soon be facing pressure - not only from Medicare, but also from commercial payers - to lower their incomes substantially.

The importance of primary care in restructuring our healthcare system is widely recognized. As a current article in Health Affairs points out, avoidable hospital admissions for asthma and diabetes complications in the U.S. are twice the average for advanced countries, and that isn’t because the United States has a greater prevalence of these conditions.

Major changes in the healthcare delivery system are coming, and they will affect every physician. The question is whether those changes will have the effect we all want or whether they will lead to unintended consequences that we don’t want.

The historic reform bill that Congress passed on Sunday will immediately affect physicians, but the impact will be much greater in the long term.

Many pundits have weighed in on the likely consequences of not passing healthcare reform, which is expected to come to a head within the next few days. But a recent blog post by Matthew Mintz, MD, an internist in Washington, DC, puts things in perspective for physicians.