An audience member asked Nesse and two others on a panel what the chances were of the CMS meeting its goal of getting 150 organizations to sign up as accountable care organizations under the proposed rule. Nesse predicted zero to 5% of the goal, while the other panelists said there was no chance anyone would apply to be an ACO if the rules stand as proposed. Nesse then clarified his prediction by noting that “at any given week, there's probably a rate of psychosis of around 5%.”
In a session on new models of integrating physicians into a health system, Kaplan followed two speakers affiliated with Northern California's Sutter Health, and began by knocking the previous presenters' maps as “California cute” because they used clip art of grape clusters and pine trees. Kaplan noted there was a reason the empty spaces on his map were filled with nothing but the color yellow: There's nothing there but corn.
Kaplan, a product of Chicago's famed comedy improv schools, explained why his system's integration includes physician-leadership training. He asked how many attendees have spouses begging them to move to Iowa. When no one raised a hand, Kaplan said, “That's why we have the Iowa Physician Leadership Training Academy—we have to grow our own.”
For those who do move to or visit Iowa, Kaplan offered this bit of advice: Never attempt to take a back-road shortcut in the spring or fall. If you do, he warned, “You'll be stuck behind a big green machine driven by a Medicare beneficiary going 6 miles per hour.”