Accountable care, like political ads during a presidential campaign, is everywhere these days. And like Kristen Stewart and Robert Pattinson, the frenzy around accountable care organizations have left them overexposed.
For a change, I bring you news of health payment reform that is not accountable care. Starting in September, Kaleida Health, a Buffalo, N.Y.-based health system, will try out an alternative payment model that will put Kaleida's doctors and hospitals at financial risk for the cost of patients' avoidable medical complications.
The experiment, with Blue Cross and Blue Shield of Western New York, will test bundled payments for coronary artery bypass graft surgery using the Prometheus payment formula.
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The Mayo Clinic entered the taxable public debt market for the first time last week and borrowed $300 million at a cost comparable to tax-exempt bonds but with less hassle.
Rick Haeflinger, assistant treasurer and investment officer for the Rochester, Minn., health system, said the price in taxable markets was competitive with tax-exempt markets and direct placement debt, which has emerged as another alternative to the more regulated municipal bond markets.
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Diversity is a big issue in healthcare and not just with patients, caregivers and executives. It turns out there's diversity in financial incentives that are part of the accountable care organization phenomenon.
In Maryland, doctors will be paid bonuses later this year tied to quality reporting under a new shared-savings payment model. The experiment includes the state's five largest insurers and Medicaid managed care.
In Minnesota, early results of bundled payments for heart attacks did not yield savings, but similar payments for diabetes, hypertension, coronary artery disease and hip and knee replacements appear on track to share savings with providers in Illinois and Pennsylvania who have had success reducing potentially avoidable complications.
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Not-for-profit hospitals cannot escape a weak economy, and the sector won't get through the next few years as easily as it did the Great Recession.
That's essentially what analysts said last week in reports from two of the major ratings agencies.
As I have reported previously, hospitals came out of the worst recession since the Great Depression with solid margins. Hospitals protected those margins by holding onto cash and cuts to spending on labor, supplies or services.
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Pay doctors to churn through patients, procedures and tests, and they will. As a business model, “do more, earn more” has been singled out by policymakers and the industry as deeply flawed and one reason the U.S. spends so much on healthcare.
But, as two health policy experts point out in the Aug. 8 Journal of the American Medical Association, efforts to find another way—including accountable care—have so far produced little change.
Payment for each procedure or visit continues to underpin many emerging accountable-care organizations, including Medicare's popular shared savings program, wrote Drs. Allan Goroll of Harvard University Medical School and Stephen Schoenbaum of the Josiah Macy Jr. Foundation.
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How much does a swing cost? For Accretive Health, the price it paid was $9.2 million.
Accretive Health may have swiftly settled a lawsuit with Minnesota's attorney general, but it cost the company, a new securities filing shows.
“Due to lost operating margin and stranded personnel costs arising from the Minnesota litigation and resulting contract terminations and associated legal defense and crisis management costs which together aggregated $14.6 million, the company had a net loss of $0.6 million as compared with a net income of $8.6 million in the second quarter of 2011,” the filing said.
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The uproar in Minnesota and Congress caused by an inquiry into Accretive Health's business practices apparently did not totally unnerve the company's first and largest customer.
Ascension Health, the nation's largest not-for-profit health system, accounted for nearly 41% of Accretive's revenue at the end of March. Ascension Health also owns 7% of the Chicago-based billing and collection company.
Accretive—which settled a lawsuit last week with Minnesota's attorney general by promising to stay out of the state for two years—disclosed in a filing with the Securities and Exchange Commission that Ascension has renewed its contract for another five years.
Accretive admitted no wrongdoing and continued to reject allegations that it violated patient privacy, debt collection and consumer protection laws.
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Economists, physicians and policymakers have put forward alternative arguments for how to best curb health spending in separate papers published online by the New England Journal of Medicine.
What follows are summaries of the pair of proposals, one that relies on state regulation, federal incentives and Medicare policy to push reforms and another that would convert Medicare from a guarantee of benefits for seniors into a program that provides enrollees with a subsidy to buy insurance.
The former was recommended by nearly two dozen health policy experts including recognizable names such as Dr. Donald Berwick, former head of the agency that oversees Medicare and Medicaid; David Cutler, a Harvard University health economist; and Peter Orszag, former director of the Office of Management and Budget.
The 23 authors made 11 recommendations, which you can read in full here (PDF). The list, they wrote, included proposals with a chance of working and being adopted.
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