k********n
发帖数: 756 | 1 Let us just face the fact: there are blue left side and red righ side. And
the press can twist the facts to create a headline that suits their bias.
And I was apalled by reading the posted article next door 1 month later
after reading the origianl analysis. So, let me post another article from a
more neutral media than the well known right leaning WSJ.
http://projectmillennial.org/2013/07/16/these-arent-mixed-resul
After a slew of disheartening press releases from CMS about the Affordable
Care Act’s growing pains, the Obama Administration is probably quite happy
to see the initial results of one of the law’s most important provisions:
Accountable Care Organizations (ACOs). You should be, too.
But the framing of the results may give the typical reader a false
impression of what’s actually transpired. From an article by Melinda Beck
in the Wall Street Journal titled “Mixed Results in Health Pilot Plan”:
All of the 32 health systems in the so-called Pioneer Accountable Care
Organization program improved patient care on quality measures such as
cancer screenings and controlling blood pressure, according to data to be
released Tuesday by the Centers for Medicare and Medicaid Services. But only
18 of the 32 managed to lower costs for the Medicare patients they treated
—a major goal of the effort. Two hospitals lost money on the program in the
first year.
Does that sound mixed to you? Let’s restate it a bit, with two charts for
emphasis:
All of the 32 health systems in the so-called Pioneer Accountable Care
Organization (PACO) program improved patient care on quality measures such
as cancer screenings and controlling blood pressure. 18 (56% of PACOs)
managed to lower costs for the Medicare patients they treated, saving $140
million in costs; of that, they’ll receive $76 million, and $33 million
will be returned to the Medicare Trust Fund. Only two of the 32 PACOs lost
money in the first year.
Or, in charts:
Put that way, it sounds a bit more successful, right?
Partners Healthcare, the Boston-area hospital conglomerate, was one of the
winners, and will get a check for $7 million from CMS. Of the two PACOs to
lose money, one did so, its executive director said, because its cost
baseline was artificially low; it will cut a check to CMS for $2 million.
Even so, it isn’t one of the nine that are reported to be leaving the
program; it’s sticking around.
Make no mistake: these aren’t mixed results. These are unambiguously
positive results for one of the most important provisions in the Affordable
Care Act.
Should we have expected all 32 PACOs to save money in the first year of a
nascent program? Probably not. And they didn’t; 44% either failed to reduce
costs or lost money on the program. But, as the director of CMS’s
Innovation Center put it, we shouldn’t have expected all 32 to improve
patient care, either: “It’s very rare that 100% of the participants
outperform benchmarks.” And they did.
This is only the first year of a program that is reinventing the way the
American health care system operates. And it worked. Full stop.
Three-quarters stop, actually: it’s important to keep in mind that the
PACOs are, well, weird. For starters, they are Pioneer ACOs because they
already had ACO-like qualities, so they have a head start on other hospital
systems and are perhaps uniquely qualified to initially succeed. Then there
’s the fact that they self-selected into a brand-new program that could
cost them millions in missed Medicare reimbursements; their finance
departments crunched the numbers and guessed that they could make money (or
at least wouldn’t lose money). Most were right. And PACOs operate under
slightly different rules than the average ACO will, starting in 2014; for
the first two years, for example, PACOs are playing under the old fee-for-
service rules, then will move to global payments, and only PACOs have two-
sided risk – they can share in savings and losses, while typical Medicare
ACOs will only share in savings.
In other words, PACOs aren’t “average” health systems, and they aren’t
“average” ACOs; it’s obviously premature to say that all ACOs will work.
Still, that doesn’t invalidate these results, and it doesn’t invalidate
the hope that ACOs are one policy innovation that can help bend the cost
curve in a real, significant way.
More information is set to be released later today, so we’ll have a better
handle on the magnitude of the savings compared to total spend,
implementation costs, reporting costs, etc. We’ll link the report here
after it’s released. | A*******s
发帖数: 9638 | 2 It is still too early to say, but I only see the bureaucracy will be up with
this ACO/Obamacare. |
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