Posts Tagged ‘Health care’
April 9, 2010
It’s time to remember ACOs, the latest acronym on many lips in Washington and included in the recently passed health reform legislation. The idea—reward providers for bringing high level quality and cost-efficient, coordinated care to communities. ACOs are envisioned as community-based entities accountable for comprehensive healthcare services. They’re supposed to promote accountability and develop patterns of practice considered to be the best and most effective. Additional Medicare payments will be given to those groups of providers that work together to manage and coordinate care for Medicare beneficiaries—of course, if they can show that they met certain quality criteria, achieve specified cost savings, and meet structural requirements for reporting and governance (to be outlined by the Centers for Medicare & Medicaid Services (CMS).
You’ll find ACOs under section 3022 of the new Patient Protection and Affordable Care Act (that’s the PPACA), which calls for the establishment of the ACO program no later than January 1, 2012. The Secretary of the Department of Health and Human Services will determine the policies and procedures that will apply to ACOs.
Who’s eligible? An ACO may be formed by a wide range of professionals, including physicians in group practice arrangements, networks of individual physician practices, hospitals, and partnerships or joint ventures between hospitals and physician groups, that are willing to be held to the accountability standards.
Among the qualifications: Providers must agree to participate in the program for at least three years and they have to have the HHS Secretary assign it at least 5,000 Medicare beneficiaries and include a sufficient number of primary care physicians for serving those patients. The Secretary can give preferences to ACOs that participate in similar arrangements with private third party payers.
The ACO is not a new idea, but rather builds on ideas and models (from Mayo to Kaiser health) that have been discussed for years. Cost savings and quality improvement are key. How that will be achieved, measured, and evaluated is still open to question, with critics noting this could be managed care in disguise. And if the patients sense a “warmed over” product focused on cost-savings, the hopes for real success could be dimmed. The division of savings could make some family physicians uncomfortable with ACOs, according to the American Academy of Family Physicians. As the degree of risk borne by ACOs increases, the need for regulation of the financial security of these organizations will also increase, which could influence patient care decision making. Financing and regulatory policies will still continue to create pressures in ways that may take the focus off the patient.
But that gets to the cost issues again. If the focus is on how to best coordinate the care of Medicare beneficiaries—and they may mean more connections rather than less connections to a host of other providers and community and social service agencies than envisioned in this plan. Whether this will be a successful evolution—or revolution—remains to be seen.
Tags: accountable care organization, American Academy of Family Physicians, centers for medicare & medicaid services, CMS, Health care, health care financing, Medicaid, Medicare beneficiaries, primary care, United States, United States Department of Health and Human Services
Posted in Health Reform, Patient Protection and Affordable Care Act, Policy, health insurance | 1 Comment »
March 25, 2010
President Obama is on the road selling health reform and showing the leadership that many Americans expected of him much earlier in his presidency. You have to sell the American people not only on the value of health care for the individual but also the benefits of caring for your neighbors, friends, communities, and the nation. Sometimes Americans forget the values and principles upon which we built this country.
At a recent International Forum in Washington, health leaders from around the world were congratulating me and other Americans because our nation finally made the grade, so to speak, with regard to health care. The U.S. finally recognized that health care is national issue–that translates into security economic growth and prosperity for the nation. Most of all, it means that our nation has finally learned that the role of government is to protect and take care of all the people who believe in justice and democracy.
Tags: American Justice, American Values, Health care, Health Reform, National Economy, president Obama
Posted in Health Reform, News, Policy, health insurance, president Obama | No Comments »
March 11, 2010
As President Obama stumps the country trying to regain leadership on health reform—and get the health reform bill passes—he is now taking aim at the health insurers. Citing big rate increases for buyers of individual insurance policies in some states — 40 percent, 60 percent, even 100 percent — Mr. Obama is trying to focus attention on provisions in the legislation that he says will protect consumers from the worst excesses of insurers.
Is this too little too late? Where was the President’s voice early on? The process the President set in motion months ago has clearly emboldened the insurers and pharmaceutical companies. One could argue that they know now that nothing substantive will change and they have carte blanche to do whatever they want.
HHS Secretary Sebelius is also confusing the insurance issue. Today she told insurers, “It’s not too late to work on this issue together, for insurance companies to come to the table and work with us.’’ Last week, the Secretary was attacking rate hikes by insurers in California.
It’s hard for the American public to get the Administration’s message straight. The President and the Secretary have not focused on the day-to-day actions of the insurers that people can relate to and understand. The insurers have gone hog wild on restrictions on drugs and services and pre-certifications for drugs and services. People experience that every day. People are frustrated and fighting that every day—and time and energy with the insurers (I should say with a recorded message machine that the insurers hide behind). That’s the insurance industry the American people know. Who will monitor that? Where is that in health reform? Will supporting health reform get the insurers out of medical decision making? That is what the people want and that is what the President is not addressing.
Tags: Barack Obama, Health care, health insurance, Health Reform, Insurance, kathleen sebelius, President of the United States, United States, United States Secretary of Health and Human Services
Posted in Health Reform, News, Policy, Uncategorized, health insurance, president Obama | 1 Comment »
February 5, 2010
President Obama –and the Congress for that matter–need to focus on JOBS in the HEALTH WORKFORCE. The Bureau of Labor Statistics reports that the health sector ranks high among the areas that will provide the greatest number of new jobs over the next decade. Four million jobs will be created in the health care sector will be a leader in producing new jobs, including high-skill, high-paying jobs like doctors and nurses. Among the top ten occupations needed will be: Registered nurses, home health aides, personal and home care aides, and nursing aides, orderlies and attendants.
With the aging baby boomer population, the need for a greater number of trained people in the health professions goes well beyond nurses and home care workers. Shortages across the professions will be exacerbated by the retirement of physicians, nurses, pharmacists, dentists and other professionals. In 2004, 23 percent of licensed pharmacists, for example, indicated they were leaving the profession within the year and 80 percent of pharmacy directors said they would leave within the decade. Substantial retirements of faculty in all schools of the health professions add to the problem.
With the overwhelming need for a health workforce for the nation, President Obama should be focusing his Jobs Initiative on education and innovative training programs for the health workforce. President Obama should be looking for ways to provide incentives to academic health centers and their health professions schools for new ideas and innovative ways to develop a quality health workforce in a short time frame.
One way is to receive funding and other incentives to create new career ladders for those people who are already employed within the health system and want to raise their skill levels and receive education in one of the more-skilled professions (and this can include the myriad allied health, imaging, medical records and IT jobs that are critical to the system).
There should also be funding to health professions schools to create innovative, perhaps fast tracked, retraining programs for the thousands of people who are losing their jobs in America’s dying manufacturing industries.
The Obama Administration needs to look beyond small business and the green industries with regard to JOBS. The health workforce should be the priority when it comes to jobs.
Tags: Academic Health Cdnters, allied health professions, Bureau of Labor Statistics, dentists, Health, Health care, health professions schools, health professions shortages, Home Health, job retraining, job training, jobs, Nursing, pharmacists, physician shortages, president Obama, Registered nurse, Service Providers, United States
Posted in News, Policy, health workforce, jobs | 3 Comments »
December 17, 2009
Two people recognize the health reform bill is not reform and are signaling that we need to start anew.
Sen. Bernie Sanders, the Independent from Vermont, is telling the world that the proposed legislation is not good. Yesterday, he said that he could not accept the health reform bill in its current form because it does not control costs or rein in health insurance companies. More important, Senator Sanders showed the courage of his convictions and brought a real answer to the Senate and the American people. He proposed a single-payer amendment to the current bill. In calling up his amendment, Sanders said, “For the first time in American history, the Senate will debate a proposal to create a single-payer, Medicare-for-all health care system.” Unfortunately, Senator Tom Coburn (R-Okla.) objected to Mr. Sanders’s request to dispense with the reading of the 767-page amendment (as called for earlier by Coburn). After nearly three hours of listening to a team of Senate clerks read the proposal, Mr. Sanders gave up and withdrew his amendment (Why, Bernie? There’s nothing to fear but fear itself.)
(Of course, Coburn knew that would be the outcome because the dealy would prevent a vote on a funding bill for the Department of Defense. The current funding provision expires at midnight tomorrow).
George Will reflects today in The Washington Post on the latest CNN poll showing that 61 percent of the public oppose what the Democratic Senate is trying to do to health care. “It is clear what the public wants Congress to do: Talke a mulligan and start over.”
Bernie and George are both saying that what we have is not good enough. President Obama should say the same and ask for the creation of a “super special” congressional committee to start anew in January. Health reform before the holidays may not make the season jolly.
Tags: George Will, Health care, health insurance, health policy, Health Reform, president Obama, Senator Bernie Sanders, Senator Tom Coburn, Single-payer health care, United States, United States Congress, United States Senate, Washington Post
Posted in Health Reform, Policy, health insurance, president Obama | No Comments »
August 20, 2009
The pressures to cut health care costs are enormous, but these cuts can also be a double-edged sword. Certainly, no one would argue against cutting fraud and overuse. But at a time when job creation is so important, the health sector is and will be a key player. These jobs are not just for a broad variety of health care providers, but also for a large range of administrative and management positions. A recent article points this out by focusing on individuals who cross over from other economic sectors to work in health care. As health care exceeds one-sixth of the economy and one out of every ten jobs, it becomes increasingly difficult to disentangle needed job growth from excessive health care spending in terms of driving the economy. This is especially true if there is some kind of health reform that increases access to a substantial number of persons who are currently either uninsured or underinsured. As we have pointed out in our report, Out of Order, Out of Time: The State of the Nation’s Health Workforce, we need to gain a more in-depth understanding of the kinds and numbers of health providers that are needed to take care of patients now and in the future. Perhaps by engaging in this discussion we can address the complex issues around “right-sizing” health care.
Tags: Health care, Health Reform, health workforce, job creation, jobs, the economy
Posted in Health Reform, health economics, health workforce | No Comments »
July 16, 2009
I read that countless numbers of people are worried about being regulated by government in any reformed health system. But no one, especially policymakers, seems to be addressing the regulatory infrastructure and the costs of regulation, which might open up a pandora’s box and really shed light on the extent to which the public is benefiting from the regulations developed to protect the American people (which is an issue for a longer discussion). No one is asking whether the agencies mandated to regulate, including the Centers for Medicare & Medicaid Services, have the resources to address implementation and enforcement of current and new regulations. Policymakers should be addressing those resources now. Policymakers would also do well to look at the costs of compliance for the government and for health care providers. A 2005 study by the Association of Academic Health Centers found that the costs of compliance increased up to 300% in the previous decade and often more than 70% a year at academic health centers throughout the nation. We are hearing of even greater increases at the present time. No one is denying the need for accountability and protecting quality, safety, and privacy in the health care arena. But it may be time for the government to ask about the costs and benefits of regulation along with addressing the need for rational and ”smart” regulations. There is also an urgent need for harmonization within the regulatory environment. Interagency task forces have done little to ensure there is no contradiction and confusion between regulations coming out of the many government agencies. If we really want to ensure safety and quality for the public as well as savings in health care delivery, reform of the regulatory world must be addressed now.
Tags: association of academic health centers, centers for medicare & medicaid services, costs of regulation, Health, Health care, health policy, Health Reform, Patient safety, regulation
Posted in Health Reform, Policy | No Comments »
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