Robert KoenigsbergFeb 27. 2015 4:50pmRobert Koenigsberg20150227/article/20150225/NEWS/150229939
This occurs quite often in California with medical groups whose board members are practicing physicians and benefit financially by assuring that they are the exclusive providers of services for the community that they serve. It goes one step further as the committees within these medical groups for different disease states are headed up by these same physicians who have kept the status quo in effect since the beginning of managed care. The Department of Managed Care oversees these organizations with little direct supervision of their activities. This keeps competition from becoming contracted to provide medical services in a given area. This is starting to change now that the medical groups are being held accountable for positive outcomes and are increasingly at risk for lowering both diagnosis and treatment costs.
KEVIN MOWLLFeb 26. 2015 2:48pmKEVIN MOWLL20150226/article/20150225/NEWS/150229939
Replacing the fee for service payment model with something better is, as they say, necessary but not sufficient to achieve healthcare reform goal of the Triple Aim. ACO-like payments may be a carrot, but there are existing obstacles in the way of those seeking to grasp it. The story is more complex and nuanced than an âeither / orâ decision about payment methodology. It helps to start with the acknowledgement that FFS has toxic consequences, of course, but the system of healthcare that grew up feeding on that payment model accommodated itself to that âfood chainâ, and its structures, processes and cultures are tightly interwoven in its grip. So systemic transformation of all of these dimensions is what is required in addition to payment reforms.
In terms of models to drive this kind of holistic change, the Medicare Pioneer and MSSP ACO models have had serious flaws. By viewing the proposed new rules for âversion 2.0â MSSP program, you can see that CMS recognizes some of the problems which they propose to amend. The original rules of the game were themselves partly to blame.
But, in many cases, the legacy structures of healthcare delivery cannot escape the gravity of their fee for service payment roots because they are too much a creation of that outdated âfood chainâ to transform themselves from within. Therefore, it is understandable that there should be significant numbers of failures to thrive under the new model. We need some time for rapid cycle learning.
Wayne CaswellFeb 25. 2015 8:36pmWayne Caswell20150225/article/20150225/NEWS/150229939
Don't expect the cost for a given service, such as a knee replacement, to change much with a different payment model. The cost savings come from fewer unnecessary tests, procedures and drugs, and from incentives focused on prevention and wellness that help eliminate the need for those medical services.
Our current sick care system trains doctors to diagnose illness, treat symptoms, and perform procedures or prescribe drugs. There's very little training on the pillars of health (nutrition, exercise and sleep), because that goes counter to a business model that profits from illness and injury.
The alternative might be the concierge-structured, direct-pay, functional medicine practice which saves time/labor/money expended on insurance issues and uses it to actually serve patients and their real needs, not the needs of third parties.
4 Readers' Comments
This occurs quite often in California with medical groups whose board members are practicing physicians and benefit financially by assuring that they are the exclusive providers of services for the community that they serve. It goes one step further as the committees within these medical groups for different disease states are headed up by these same physicians who have kept the status quo in effect since the beginning of managed care. The Department of Managed Care oversees these organizations with little direct supervision of their activities. This keeps competition from becoming contracted to provide medical services in a given area. This is starting to change now that the medical groups are being held accountable for positive outcomes and are increasingly at risk for lowering both diagnosis and treatment costs.
Replacing the fee for service payment model with something better is, as they say, necessary but not sufficient to achieve healthcare reform goal of the Triple Aim. ACO-like payments may be a carrot, but there are existing obstacles in the way of those seeking to grasp it. The story is more complex and nuanced than an âeither / orâ decision about payment methodology. It helps to start with the acknowledgement that FFS has toxic consequences, of course, but the system of healthcare that grew up feeding on that payment model accommodated itself to that âfood chainâ, and its structures, processes and cultures are tightly interwoven in its grip. So systemic transformation of all of these dimensions is what is required in addition to payment reforms.
In terms of models to drive this kind of holistic change, the Medicare Pioneer and MSSP ACO models have had serious flaws. By viewing the proposed new rules for âversion 2.0â MSSP program, you can see that CMS recognizes some of the problems which they propose to amend. The original rules of the game were themselves partly to blame.
But, in many cases, the legacy structures of healthcare delivery cannot escape the gravity of their fee for service payment roots because they are too much a creation of that outdated âfood chainâ to transform themselves from within. Therefore, it is understandable that there should be significant numbers of failures to thrive under the new model. We need some time for rapid cycle learning.
Don't expect the cost for a given service, such as a knee replacement, to change much with a different payment model. The cost savings come from fewer unnecessary tests, procedures and drugs, and from incentives focused on prevention and wellness that help eliminate the need for those medical services.
Our current sick care system trains doctors to diagnose illness, treat symptoms, and perform procedures or prescribe drugs. There's very little training on the pillars of health (nutrition, exercise and sleep), because that goes counter to a business model that profits from illness and injury.
The alternative might be the concierge-structured, direct-pay, functional medicine practice which saves time/labor/money expended on insurance issues and uses it to actually serve patients and their real needs, not the needs of third parties.