Health Care Interests Push To Make ACOs Pay Off For Them - Kaiser Health News

By Phil Galewitz and Jenny Gold

A new model of care encouraged by the health law – accountable care organizations – has set off a feeding frenzy among industry groups intent on getting a slice of the action, or protecting their own financial interests.

"ACOs are the latest fad," said Dan Hawkins, senior vice president for policy and research at the National Association of Community Health Centers. "I call them the hula hoop of health care because everyone wants one even if they haven't actually been defined anywhere. The whole doggone health care community is in a frenzy to own and dominate these ACOs."

For now, ACOs are just a concept – federal regulators haven't yet drawn up the rules. As envisioned by the law, ACOs would be integrated delivery systems involving doctors, hospitals and other providers whose pay would be partly based on meeting certain quality and cost targets. The goal: to improve care and slow rising costs. Medicare will start using them in 2012; many providers already are developing them for the private insurance market.
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H.R. 3556: To require the Secretary of Health and Human Services to establish a self-referral disclosure... (GovTrack.us)

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To require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act.

Sponsor: Rep. James McDermott [D-WA7](no cosponsors)

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Occurred: Introduced Sep 14, 2009
Occurred: Referred to Committee on Ways and Means

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Another Drug Maker to Report Payments to Doctors

Posted by Jacob Goldstein in the Wall Street Journal Health Blog The pharma transparency bandwagon is filling up, as drug makers pile on to report their payments to physicians. Now GlaxoSmithKline has climbed aboard, the Financial Times reports . Besides publicly reporting what the company pays docs (presumably for things like consulting and giving speeches), Glaxo will also cap payments at $150,000 per year. Merck and Eli Lilly are among the companies that have already said they’ll make public at least some of their payments to doctors. Transparency could soon be forced on the whole industry, willing or unwilling: The Physician Payment Sunshine Act, sponsored by an influential senator, Chuck Grassley, would require drug and device makers to regularly report their payments to doctors.

McCain and Obama Agree: Medicare Needs New System for Doctor Pay

Posted by Jacob Goldstein in the Wall Street Journal Health blog McCain and Obama have big differences about how America’s health insurance market should work (duh). But their views converge when it comes to the way Medicare pays doctors — and their advisers have suggested both would shift the system away from the current model, which gives doctors a financial incentive to do lots of high-end procedures, even if they’re not entirely necessary.

Certificate-of-need law in Illinois slammed by feds, AMA

By Amy Lynn Sorrel, AMNews staff. Oct. 6, 2008. Illinois' certificate-of-need law and similar statutes in other states undercut consumer choice, stifle innovation and generally have failed to keep health care costs down, according to a joint statement by the Federal Trade Commission and Dept. of Justice.

“Medical Licensing: An Obstacle to Affordable, Quality Care.”

Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions entirely to the private sector and the courts.

Beyond Pay for Performance — Emerging Models of Provider-Payment Reform

Meredith B. Rosenthal, Ph.D. in New England Journal of Medicine Volume 359:1197-1200 September 18, 2008 Number 12 Escalating costs and the growing imbalance between primary and specialty care have increased the urgency of calls for fundamental reform of the health care payment system. At the core of the problem is the fact that the dominant fee-for-service model rewards volume and intensity rather than value. But although the faults in the way we currently pay for health care are obvious, it is much less clear what feasible approach would yield better results.

The Problems With Paying Doctors for Performance in Health Care

Posted by Jacob Goldstein in the Wall Street Journal Health Blog Everybody’s trying to figure out how to create a health system that ties payments to the quality of care. But measuring quality of care is maddeningly difficult.

Extra Payments to Medicare Advantage Plans to Total $8.5 Billion

The higher payments for Medicare Advantage plans were originally intended as an upfront investment to stabilize plan participation and increase beneficiary enrollment, with the hope that the plans would eventually drive down the explosive growth of Medicare spending. Even if recently mandated payment reductions to private Medicare Advantage (MA) plans--scheduled to take effect beginning in 2010--had been fully in place in 2008, the plans still would have been paid 10.6 percent more than expected fee-for-service costs, say the authors of The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans in 2008.

HHS Designates 11 Communities Working to Improve Quality and Value

HHS Secretary Mike Leavitt today welcomed 11 more communitycollaborations to a growing national movement to build a health caresystem where consumers, providers and payers make decisions based on thevalue and quality of care. These communities will join 14 others as Chartered Value Exchanges(CVEs) -- local collaborations of health care providers, employers,insurers, and consumers working jointly to improve care and make qualityand price information widely available. The new Chartered Value Exchanges are as follows: o Aligning Forces for Quality, York, Pa. o California Chartered Value Exchange, San Francisco, Calif. o The Colorado Chartered Value Exchange, Denver, Colo. o eHealth Connecticut, Inc., Middletown, Conn. o Greater Louisville Value Exchange Partnership, Louisville, Ky. o Health Improvement Collaborative of Greater Cincinnati andHealthBridge, Cincinnati, Ohio o Kansas City Quality Improvement Consortium, Kansas City, Mo. o Michigan Health Information Alliance, Mt. Pleasant, Mich. o Nevada Partnership for Value-driven Health Care, Las Vegas, Nev. o Quality Health First program, Managed by the Indiana HealthInformation Exchange, Indianapolis, Ind. o Virginia Health Care Alliance, Glen Allen, Va. As Chartered Value Exchanges, these communities will have access toinformation from Medicare that gauges the quality of care thatphysicians provide to patients. These performance measurement resultsmay be combined with similar private-sector data to produce a morecomprehensive guide to the quality of care in these communities.

Emerging Health Care Competition and Consumer Issues

Public Workshops and Roundtables: Emerging Health Care Competition and Consumer Issues SUMMARY: The Federal Trade Commission (``FTC'' or ``Commission'') announces it will hold two workshops and roundtables in the fall of 2008 on emerging health care competition and consumer issues. They will focus on two distinct areas in which competition and consumer protection policies are implicated: (1) competition provided by developing an abbreviated regulatory approval pathway for follow-on biologic drugs; and (2) competition among health care providers based on quality information. The workshops and roundtables will be held at and administered by the FTC and their dates will be announced in a separate public notice. This notice poses a series of questions for which the FTC seeks public comment. The Commission will consider these comments as it prepares for the public workshops and roundtables. In the spring of 2009, the FTC will release a report that analyzes the potential impacts on the marketplace of various policy options in these two areas. DATES: Specific dates for the workshops and roundtables will be announced shortly, along with an agenda. Comments on the questions contained in this Notice must be received on or before September 30, 2008. In addition, any interested person may submit written comments to any of the topics addressed during the workshops. Comments directed at a particular subject considered in a workshop or roundtable must be received no later than 30 days after the date of that workshop or roundtable.

Factors Influencing Consumer Choices Among Health Plans and Clinicians

``Study of Factors Influencing Consumer Choices Among Health Plans and Clinicians'' This study will use an experimental design to determine factors that influence consumer understanding and use of performance information to select among health plans and clinicians. Performance reports on health plans and individual providers have become increasingly available in recent years, but there is little evidence regarding how consumers understand and use different types of performance information to make choices. DATES: Comments on this notice must be received by November 3, 2008.

Legal risk for prescribing painkillers is small, study says

By Kevin B. O'Reilly, AMNews staff. Sept. 8, 2008 Researchers say that relatively few doctors were charged between 1998 and 2006, but critics find that interpretation paints a misleading picture.

Practices hit Medicare P4P quality targets, but bonuses still fall short

By Geri Aston, AMNews correspondent. Sept. 8, 2008 Only four of the 10 physician groups received performance pay, despite a near-perfect record on quality measures.

Homelessness Services: Web 2.0 Connects Providers

It’s the latest computer buzzword. But how can Web 2.0 be useful to service providers who work with people who are homeless? Young and well educated, but overworked and underpaid, providers operate in programs with few resources for expensive computer hardware. They are tech-savvy and computer literate, and they are ripe for SAMHSA’s Homelessness Resource Center (HRC), a virtual community that shares state-of-the-art knowledge and promising practices to prevent and end homelessness.

The Lucrative Life of a Nonprofit Hospital

Posted by Jacob Goldstein in the WSJ Health Blog Nonprofit medical centers are big business these days. Carilion Health System, in Virginia’s Roanoke Valley, had profits of more than $100 million last year, this morning’s WSJ reports. Critics say big medical centers like Carilion use near-monopoly power to charge high prices; Carilion says it needs to charge more for some procedures to subsidize other parts of its business, such as care for the uninsured. And the hospital says an HCA-owned hospital in a nearby town offers competition.

Are Hospitals Grabbing a Bigger Share of the Healthcare Pie?

By David P. Hamilton in the Health Care Industry blog The U.S. healthcare system is sometimes best thought of as a three-way tug-of-war between payers (private insurers and the feds), providers (hospitals and doctors) and suppliers (drug and medical-device makers). No, patients don’t really figure into this analogy — at best, they’re trussed up in the middle somewhere. Most big changes in the system result when one of the three players temporarily seizes the upper hand.

Nevada ruling may compound end-of-life care decisions

By Amy Lynn Sorrel, AMNews staff. Sept. 1, 2008. A recent Nevada Supreme Court ruling may open the door for physicians' medical judgment to be questioned in end-of-life care decisions and make their role in such scenarios more difficult, some experts said.

Eli Lilly Grants Report

Posted by Jacob Goldstein in the Wall Street Journal Health Blog A week after a Senate committee released a report on charitable and educational contributions made by drug companies, Eli Lilly is releasing its own detailed report on the grants it makes to nonprofit groups, educational institutions and for-profit educational companies. The company gave away $11.8 million in the first quarter of 2007. That included big grants to well-known organizations — Massachusetts General Hospital ($848,750), National Alliance for the Mentally Ill ($544,500), the American Medical Association ($249,500) — as well as smaller gifts to more obscure groups — Central Indiana Association of Pharmacists ($4,000), Greater Saint Stephen Health Ministry ($10,000), Hispanas Organized for Political Equality ($10,000). The industry says grants like these help educate doctors and patients. But some critics have said that such funding skews educational content in favor of the industry and the drugs it produces. Lilly’s decision to post the information each quarter on a public Web site may allow critics and supporters to track the grants more easily and to gauge whether they’re appropriate.

GLAXOSMITHKLINE To Post Quarterly US Grants Report

GlaxoSmithKline announced that, beginning in February 2009, the company will proactively report educational and charitable grants provided to US health-related organizations. The report will be updated on a quarterly basis and will include grants provided to various organizations including hospitals, teaching institutions, managed care organizations, professional associations, patient advocacy groups, and continuing medical education companies. GSK provides grants for programs and organizations that foster increased understanding of scientific, clinical, and healthcare issues, and contribute to the enhancement of patient care.