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Park Nicollet’s experiment with ACOs – TwinCities.com
In 2005, Park Nicollet Health Services started participating in a pilot project that was the first to test the idea of “accountable care organizations” in the federal Medicare program.
Called the Physician Group Practice Demonstration Program, Park Nicollet was one of 10 large multi-specialty groups across the country that agreed to adopt a new payment relationship from Medicare for a portion of its patients.
The premise was straightforward: If Park Nicollet and other groups could provide care at a lower cost while meeting quality standards for patients, the groups would share the savings with Medicare.
But as a study published this month in the Journal of the American Medical Association shows, results from the Physician Group Practice, or PGP, project have been mixed. Overall, researchers found that the five-year pilot delivered only modest savings, although savings were larger for a subset of patients, many of whom have complex health problems.
“(Park Nicollet) received a bonus payment in only one year of the PGP,” said Carrie Colla, a researcher with the Dartmouth Institute for Health Policy and Clinical Practice. “But in the (subset), they saved quite a bit of money.”
Improving care while lowering costs for complex patients is one of the key challenges facing the nation’s health care system, said Dr. David Abelson, the chief executive officer at St. Louis Park-based Park Nicollet, during an August 2011 interview about the pilot project.
See on www.twincities.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
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From HMOs to ACOs: Meet the newest model in health care management – TwinCities.com
When critics look at health care in America, many describe a system that’s fragmented, inefficient and burdened with waste.
Doctors and hospitals generally are paid a fee for every service they provide, the critique goes, so they lack financial incentives to effectively coordinate care and make sure patients get only the services they need.
Patients often have a front-row seat on the dysfunction, critics say, as they are shuffled off to specialists without needed paperwork, undergo unnecessary tests or make repeat hospital visits when medical centers don’t get it right the first time.
Enter “accountable care organizations,” a new structure in health management that the federal government, health insurers and some physicians hope will tame the woes. Doctors, hospitals and clinics would be given responsibility to provide care for a group of patients — within a budget. If health care providers better coordinate care to provide good quality for less money, they can share in the savings.
Republicans and Democrats “agree that transitioning from fee for service to global payments in health care will be necessary in order to deal with the budget deficit,” Bottles wrote in an email. “The consolidation of the health care industry will continue no matter which party prevails in the November election.”
This push for accountable care organizations (or “ACOs”) is driving a consolidation trend among health care companies that’s increasingly being felt in Minnesota. The clearest example is a plan announced in August to combine the HealthPartners and Park Nicollet health systems into one of Minnesota’s largest nonprofit health companies, with 20,000 employees, including 1,500 physicians.
See on www.twincities.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation
Annals of Family Medicine — Sept/Oct 2012 Issue:
Conclusions: If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce.
Discussion: Solving the primary care dilemma—excessive panel sizes in an environment of a primary care physician shortage—requires the replacement of physician-only care with team-based care. Such an unprecedented change in both the culture and structure of primary care practice can be accomplished only through a change in clinician mindset, the training of nonclinician team members, the mapping of workflows and tasks, the creation of standing orders that empower nonclinicians to share the care, the education of patients about team-based care, and the reform of primary care payment. Fortunately, all these elements are being implemented in many innovative primary care practices around the United States. These practices point to a future of high-functioning primary care teams that can ensure health care access and quality for the nation’s population with a reasonable work life for physicians and other team members.
See on www.annfammed.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Team Models Could Provide Care for Increased Patient Loads | Science Codex
While patient studies show that cancer survivors don’t even want to use a primary care physician for anything more elaborate than shining a light in their ear, service surveys show that doctors are already trying to see too many patients – a problem that will only get worse when the Afforadable Care Act mandates go into force.
Primary care is facing the dilemma of excessive patient pool sizes, authors claim — the average primary care physician’s panel size of 2,300 is too large for delivering good care under the traditional practice model — and we are about to witness an environment of primary care workforce shortage, which means patient panel size will only increase.
Solution: let someone besides doctors handle a lot of stuff that some patients don’t even want their general practitioner handling.
See on www.sciencecodex.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Partnership for Patients — a public-private partnership to improve the quality, safety, and affordability of health care
The Partnership for Patients is a public-private partnership that helps improve the quality, safety, and affordability of health care for all Americans.
The Obama Administration has launched the Partnership for Patients: Better Care, Lower Costs, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable, and less costly.
The two goals of this new partnership are to:
* Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.
* Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.
See on www.healthcare.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Manoj Jain: Doctors need to eliminate waste from healthcare — Memphis Commercial Appeal
Dr. Manoj Jain is an infectious disease physician and also writes for The Washington Post. His articles can be seen on MJainMD.com.
Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine.
I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it.
In a private conversation, a cardiologist tells me about his partners — “loose guns” he calls them. “At the hint of chest pain they will do a cardiac cath and this makes everyone happy,” he says. The patient feels good that something was done, the doctor gains certainty of his presumptive diagnosis and the hospital makes money. While it may seem like a win-win-win, in fact, we all lose as the health care expenditure tops $2 trillion, siphoning funds from education, housing and business innovation.
The IOM report notes that unnecessary services are responsible for nearly a third, or $210 billion, of wasted expenditure.
I, too, order excessive services like CT and MRI scans, without regard to cost. Often these services are in the gray zone of medicine where it is unclear if some procedures are really necessary.
When we doctors talk about waste, we often beat around the bush. We know the system is full of waste, but when confronted we blame the patients or malpractice attorneys.
There is another less-talked-about reason for unnecessary services. One person’s waste is another person’s income. Another cardiac catherization, another back surgery means more income for doctors, hospitals and the health care system and its archaic administrative services.
To reduce waste, doctors need to become integral partners in the cost-cutting process.
See on www.commercialappeal.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Obama, Ryan address AARP group in dueling speeches
NEW ORLEANS, La. — President Obama, speaking Friday by satellite feed just minutes before a speech by GOP vice presidential nominee Paul Ryan, took a pre-emptive shot at the AARP’s “Life@50+” convention, telling the group not to believe the criticisms that would follow.
“Contrary to what you’ve heard and what you may hear from subsequent speakers, Obamacare actually strengthened Medicare,” Obama said.
The Romney-Ryan camp claims the president’s health care law raids Medicare of billions of dollars, and it has made that assertion a central theme of its campaign.
Speaking to the group, which counts among its membership more than 37 million people over the age of 50, the president tried to discredit that argument.
“When you hear this notion … that we somehow took $716 billion, robbed it from Medicare beneficiaries and seniors, I want you to know that is simply not true,” he said. “What we did was we went after waste and fraud, and over-charging by insurance companies, for example. Those savings do come out to $716 billion.”
Moments later, Ryan tried going on the offensive — warning the crowd of what he claims will be catastrophic consequences to Medicare if voters stick with Obama.
His message was not well received.
“The first step to a stronger Medicare is to repeal Obamacare, because it represents the worst of both worlds. It weakens Medicare for today’s seniors and puts it at risk for the next generation,” Ryan said to a chorus of boos.
See on politics.blogs.foxnews.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Medicare Advantage Enrollees Face $515 Cut to Medicare Advantage Plans
ObamaCare imposes major cuts on the popular Medicare Advantage program, and while the Obama administration has largely delayed them until after the election, enrollees will lose an average $515 in benefits in 2013, according to an IBD analysis.
Some 14.4 million people are expected to enroll in Medicare Advantage in 2013, up from 13.1 million this year, the Center for Medicare and Medicaid Services (CMS) said Wednesday. Advantage plans are run by private firms, providing more benefits at a somewhat higher cost — usually 13% to 17% — to the government than traditional Medicare.
That added cost has made Advantage plans a target. ObamaCare will cut MA by at least $7.4 billion in 2013.
See on news.investors.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Louisiana Couple sentenced in Medicare fraud case
A Plaquemine couple is headed to federal prison after admitting that they used their medical equipment company to defraud Medicare of slightly more than $1 million.
The couple admitted they billed Medicare for equipment that was either medically unnecessary or never delivered to Medicare beneficiaries. In some cases, Medicare was billed for expensive equipment for which inferior products were substituted.
Between January 2006 and March 2008, according to their charge, the Stewarts and “others known and unknown to the United States attorney” falsely billed Medicare for $1.9 million in power wheelchairs, orthotics and other durable medical equipment.
See on www.fox8live.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
ID theft scammers pretend to be Medicare reps, offer free medical supplies to get information – The Prescott Daily Courier – Prescott, Arizona
Prescott, AZ: Better Business Bureaus across the country have received calls from seniors being targeted for Medicare fraud, said Mary Hawkes, director of the BBB Yavapai County office.
“Seniors in northern Arizona report receiving calls from individuals claiming to be with Medicare offering free items such as a back brace and diabetic supplies in exchange for consumers’ financial and personal information,” Hawkes said, “Due to the high likelihood that callers are not associated with Medicare, the Better Business Bureau is alerting the senior community to be wary of calls offering Medicare benefits.”
Local seniors said after the caller identifies himself or herself as a representative from Medicare, he or she offers free items to entice consumers to provide their Medicare number, as well as insurance and personal information.
See on www.dcourier.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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Physicians Practice
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Joseph Rugg's Health Law Blog 