MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'accountable care organizations'. Sat, 03 Sep 2011 02:55:04 +0100 http://www.medworm.com/index.php?rid=5125824&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Ftraffic.libsyn.com%2Fnversel%2FVi_Shaffer_AMDIS_2011.mp3 Back in June, I covered the Wisconsin Technology Network’s Digital Healthcare Conference in Madison. That conference featured a panel with Vi Shaffer, research vice president and industry services director for healthcare providers at Gartner, Judy Murphy, vice president of information services at Aurora Health Care in Milwaukee, and Epic Systems CEO Judy Faulkner, based in nearby Verona, Wis. The panel discussed the question, “Is meaningful use a floor or a ceiling?” as I reported for WTN News. The conference also featured several sessions on how business intelligence and health information exchange can support Accountable Care Organizations. A month later, I saw Shaffer again at AMDIS Physician-Computer Connection meeting in Ojai, Calif. There, she presented preliminary ... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=5125824 Fri, 12 Aug 2011 17:24:05 +0100 5125824 http://www.medworm.com/index.php?rid=5107648&cid=t_368946_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Fneil%2F2011%2F08%2F04%2Frandom-thoughts-emr-projects-decentralized-problems-persist-despite-solutions%2F Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?) Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions. This news comes on the heels of a decision by the government of ... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=5107648 Thu, 04 Aug 2011 22:22:35 +0100 5107648 http://www.medworm.com/index.php?rid=4934435&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FcaoEF1XUOg0%2F That’s the subject of my weekly post on EMR and HIPAA, based on two stories I’ve written in the last 24 hours and a conference I attended last week in Madison, Wis. Check it out.   Related posts:CDS commentary on EMR and HIPAA blog A business opportunity and a milestone Deborah Peel on Fox Business (Source: Neil Versel's Healthcare IT Blog) Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4934435 Thu, 16 Jun 2011 21:05:28 +0100 4934435 http://www.medworm.com/index.php?rid=4820955&cid=t_368946_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F5iLWq8bfPRM%2F It’s time to call it — the Medicare Shared Savings (SS) ACO is dead-in-the-water. Ironically — at the same time — commercial payers are awakening to ACO opportunities. Please read further. (more…) Article Series - Accountable Care Organizations: Cure-du-Jour or Real Collaborative Care?The Big Idea in Understanding “Accountable Care Organizations”The Achilles Heel of ACOs? Shared Savings Payment Model Unlikely to Motivate HospitalsA Dark Horse in ACO Formation: Large Physician Groups“Does This ACO Thing Really Mean We Need to be ‘Accountable’”Will ACO IT Models Be Walled Gardens or Open Platforms?10 Reasons Why an Open IT Platform Strategy is the Right Long-Term Choice for an ACOIs Economic Credentialing A Tool for Primary Care to Lead... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4820955 Fri, 13 May 2011 23:12:43 +0100 4820955 http://www.medworm.com/index.php?rid=4820950&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2F-gmzgCD_78g%2F I’ve just finished my latest post for EMR and HIPAA, based on a session I moderated this week at the the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla. Here’s a taste: The panelists did great job of articulating some of these conundrums and strategies to overcome them, but none better than Kevin Maher, director of clinical innovations for Horizon Healthcare Innovations, a new affiliate of Horizon Blue Cross Blue Shield of New Jersey tasked with testing new care models, and Victor Freeman, M.D., quality director in the Health Resources and Services Administration‘s Office of Health IT and Quality. The patient-centered medical home is a great idea for managing care, promoting prevention and, ultimately reducing costs. “We view the ba... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4820950 Thu, 12 May 2011 21:59:53 +0100 4820950 http://www.medworm.com/index.php?rid=4813404&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FWNwZU_GkVps%2F Oh man, I’ve been busy. I filled in as writer of the Midwest edition of Payers and Providers the last two weeks because regular editor Duncan Moore, a former colleague, had been hospitalized. (Get well soon, Duncan.) I’ve been at the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla., since yesterday, and I’ve also had my regular deadlines for InformationWeek and MobiHealthNews. I moderated two IHT2 conference sessions yesterday, on how health IT underpins Accountable Care Organizations and how business intelligence can create a framework for health information exchange. I haven’t had time to blog about those, but several people seem to have tweeted during those sessions. I therefore present a rundown via Twitter. @narmi91 #iHT2... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4813404 Thu, 12 May 2011 00:13:28 +0100 4813404 http://www.medworm.com/index.php?rid=4813286&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-accountable-care-organizations-acos-will-fail-to-reduce-costs%2F2011.05.11 In an ideal world ACOs should work. There is no evidence that  untested and complex organizational structure of ACOs developed by Dr. Don Berwick (head of CMS) will improve quality of care and reduce costs. ACOs are supposed to provide financial incentives to health care organizations to reduce costs and improve quality. There are too many defects in the ACOs infrastructure to improve the financial and medical outcomes. At a conceptual level, the incentive for ACOs would be to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members would share the savings resulting from the increased coordination of care. I have said over and over again that excessive administrative fees and ineffective management of chronic disease is the m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4813286 Wed, 11 May 2011 18:00:41 +0100 4813286 http://www.medworm.com/index.php?rid=4780312&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faccountable-care-organizations-acos-hmos-with-lipstick%2F2011.05.03 Thousands of articles have been written about forming ACOs. Millions of dollars have been spent by hospital systems to try to form an ACO. Healthcare policy consultants have discovered a new cash cow. Hospitals systems are wasting their money. They think the return from owning salaried physicians’ intellectual property will be more than worth the cost. Thousands of physicians have been confused by the concept of ACO. Many have felt ACOs are an attack on their freedom to practice medicine the best they can. Many have rejected the concept because they feel they will have to be salaried by hospital systems. Many physicians do not trust President Obama or Dr. Don Berwick. The Stage 2 ACO regulations are not easy to understand. They are more ominous than the stage 1 regulations. The two cor... Better Health blogs http://www.medworm.com/rss/comments.php?id=4780312 Tue, 03 May 2011 14:00:50 +0100 4780312 http://www.medworm.com/index.php?rid=4771024&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-medical-condition-is-the-most-costly-to-employers%2F2011.04.30 Ok…here’s a brain teaser.  What medical condition is the most costly to employers?  I’ll give you a hint.  It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians. If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part. Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression.  Prevalence rates for depression are highest among women and older patients with chronic conditions.  Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians. For em... Better Health blogs http://www.medworm.com/rss/comments.php?id=4771024 Sat, 30 Apr 2011 19:00:08 +0100 4771024 http://www.medworm.com/index.php?rid=4734099&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-accountable-care-organizations-acos-will-not-solve-our-healthcare-cost-crisis%2F2011.04.20 In 2009 President Obama stated that Accountable Care Organizations (ACOs) were going to be pilot programs in real world settings. The goal was to see if they effective in reducing costs and increasing “quality of care.” The results of the pilot programs have not been published. Last week despite the lack of proof of concept HHS and CMS announced new proposed regulations for ACOs. The new delivery and payment model the agency estimates could serve up to 5 million Medicare beneficiaries through participating providers, and also potentially save the Medicare program as much as $960 million over three years. How were these estimates derived? It could be another accounting  trick by President Obama’s administration. The idea of coordinating care and developing systems of care is a great... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734099 Thu, 21 Apr 2011 01:00:07 +0100 4734099 http://www.medworm.com/index.php?rid=4709203&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-wary-of-healthcare-reform-models-intended-to-save-primary-care%2F2011.04.13 When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems. And who can blame them? Older inte... Better Health blogs http://www.medworm.com/rss/comments.php?id=4709203 Wed, 13 Apr 2011 23:00:00 +0100 4709203 http://www.medworm.com/index.php?rid=4696617&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fin-brief-new-accountable-care-organization-aco-regulations%2F2011.04.11 ACO regulations and related federal issuances hit the street last Thursday, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS.  They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to  limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt organizations. I had the opportunity to discuss the regs the day after they were issued on a special edition of the Blog Talk Radio show, ACO Watch, hosted by Gregg Masters (@2healthguru).  Gregg’s guests included Mark Browne (@consultdoc), Vince Kuraitis (@VinceKuraitis), Jaan Sidorov (@DisMgtCareBlog) and yours truly ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4696617 Mon, 11 Apr 2011 12:00:09 +0100 4696617 http://www.medworm.com/index.php?rid=4696712&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FnZFN64nSeww%2F It’s been a full decade since the Institute of Medicine published the second volume in its landmark series on patient safety and quality of care, Crossing the Quality Chasm. We appear to be not much closer to achieving a high-quality health system as we were 10 years ago. Last week, as you may have already heard, a paper in Health Affairs from researchers at the University of Utah concluded that adverse events may be 10 times more prevalent than previously believed and that errors may occur in an astounding one-third of all hospital admissions. The research team, which included such luminaries as Dr. David Classen, Dr. Brent James and the Institute for Healthcare Improvement‘s Frank Federico, also said that there estimates probably were on the conservative side. Patient-safety ... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4696712 Sun, 10 Apr 2011 21:07:53 +0100 4696712 http://www.medworm.com/index.php?rid=4676902&cid=t_368946_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FpPQ_bVNqlgg%2F Nothing like enjoying the end of the weekend by going over some tweets from interesting people in the healthcare IT and EMR world. The first one hit me the strongest since I think I sometimes get so wrapped up in the details of EMR and healthcare IT that I forget to stop and remember really why we’re doing all of this. Thanks Diane for reminding us. #bbpBox_54579505100107776 a { text-decoration:none; color:#0084B4 !important; } #bbpBox_54579505100107776 a:hover { text-decoration:underline; } What are the ends of medicine? To cure sometimes, relieve often, comfort always. Regardless of wealth or lack thereof. about 14 hours ago via ÜberSocial @DianeEMeier Diane E. Meier After John Chilmark from Chilmark Research skipped doing his taxes (thankfully mine a... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4676902 Mon, 04 Apr 2011 06:22:19 +0100 4676902 http://www.medworm.com/index.php?rid=4592493&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FopWr_wehgR8%2F President Barack Obama has made plenty of mistakes in his first two-plus years in office, but none may be more serious for the future of America than his decision to install Donald M. Berwick, M.D., as a recess appointment to head the Centers for Medicare and Medicaid Services in July 2010. Berwick really is a great choice to head CMS, but the underhanded nature of the recess appointment has provided fodder for all kinds of uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts. Just as CMS is gearing up to release widely anticipated proposed regulations for Accountable Care Organizations, we get the sad news that that Berwick’s days are numbered. After refusing to allow Berwick to testify before the Senate last year, Obama renominated Berwick on Jan. 2... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4592493 Mon, 14 Mar 2011 18:21:58 +0100 4592493 http://www.medworm.com/index.php?rid=4552049&cid=t_368946_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Frise-of-corporate-physician-end-of.html In discussing how concentration and abuse of power threatens health care professionals' values and professionalism, we have discussed how ostensibly academic institutions value faculty more for their earning power than their academic abilities.  We have discussed how financial relationships between physicians and drug, biotechnology, device and other companies risk abuse of entrusted power.  But up to now, I have been comforted by the hope that physicians in small independent practices who do not have such conflicts of interest are trying to uphold their professional values, even as they were buffeted by the perverse incentives imposed by managed care organizations/ health insurance companies and government insurance (e.g., US Medicare whose payments are controlled by the RUC).Ho... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4552049 Sat, 05 Mar 2011 16:48:00 +0100 4552049 http://www.medworm.com/index.php?rid=4545031&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Fwww.youtube.com%2Fv%2FNnYiPbIAzEQ%3Fhl%3Den%26amp%3Bfs%3D1 As has become custom at HIMSS, I sat down with Jonathan Bush, chairman, CEO and president of athenahealth, at the 2011 conference in Orlando, Fla., last week. But due to some technical difficulties in getting the room we thought we had reserved and in getting my audio recorder to work (OK, OK, I didn’t have fresh batteries on me), I busted out the HD video camera. (Wouldn’t you know, the battery was losing steam there, too, so I had to plug the camera in. I have since determined that the USB port wasn’t working, so I exchanged it this past weekend. But I seriously digress.) In this interview, we talk athena’s business, meaningful use, 5010/ICD-10, ACOs, cloud computing and health reform. We poke a little fun at the “boat show” that the vendor expo has be... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4545031 Mon, 28 Feb 2011 14:00:18 +0100 4545031 http://www.medworm.com/index.php?rid=4540615&cid=t_368946_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2F3sJs3NGMVVU%2F Valentine’s Day came and went, but the love lingers with Health Wonk Review. Louise and Jay Norris have the Valentine’s Week edition of HWR at the Colorado Long Term Care Insider blog. They’ve included my recent podcast with Evan Steele of SRSsoft, and there’s plenty of other news about health insurance reform, Accountable Care Organizations and shared decision-making between patients and providers. Check it out. (Source: Neil Versel's Healthcare IT Blog) Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4540615 Sat, 19 Feb 2011 15:00:07 +0100 4540615 http://www.medworm.com/index.php?rid=4477761&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmeasuring-the-patient-experience%2F2011.02.15 There’s a growing recognition within the medical-industrial complex that the patient is a key element of the enterprise, and that patient satisfaction, patient experience, patient engagement, patient activation, and patient-centeredness are very important. Some research shows that patient activation yields better patient outcomes, and that patient activation can be measured. Patient-centeredness and patient engagement are two of the key metrics to be used by the feds in describing Accountable Care Organizations (ACOs), if the internecine battles within government are resolved soon enough to actually release draft ACO regulations in time to allow for sufficient advance planning for the January 2012 go-live date. (Wearing one of my many hats, I’ve had the opportunity to submit ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4477761 Tue, 15 Feb 2011 14:00:44 +0100 4477761 http://www.medworm.com/index.php?rid=4455262&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fintegrating-major-health-systems-could-make-things-worse%2F2011.02.09 Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control. To that end, accountable care organizations (ACOs) have been a major part of health reform, changing the way healthcare is delivered. Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions. Monopoly power. To prepare for the new model of healthcare delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455262 Wed, 09 Feb 2011 22:00:58 +0100 4455262 http://www.medworm.com/index.php?rid=4414521&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-money-isnt-everything-to-doctors%2F2011.01.29 I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.” So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will. Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed: Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4414521 Sat, 29 Jan 2011 17:00:01 +0100 4414521 http://www.medworm.com/index.php?rid=4394444&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-the-end-of-internal-medicine-as-we-know-it-might-be-a-good-thing%2F2011.01.24 A recent post on the Health Affairs blog proclaimed “The End of Internal Medicine As We Know It.” What the post is really asking about is the future of primary care in the world of healthcare reform and the creation of accountable care organizations (ACOs). While doctors should be naturally concerned about change, I don’t completely agree with this article. ACOs are organizations that are integrated and accountable for the health and well-being of a patient and also have joint responsibilities on how to thoughtfully use a patient’s or employer’s health insurance premium, something that is sorely lacking in the current health care structure. These were recently created and defined in the healthcare reform bill. Yet the author seems to suggest that this is a s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394444 Mon, 24 Jan 2011 20:00:00 +0100 4394444 http://www.medworm.com/index.php?rid=4349515&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freferral-communication-what-happens-to-handoffs-between-primary-care-physicians-and-specialists%2F2011.01.14 Far more primary care doctors report detailed referrals than do specialists report receiving them. The same applies in reverse. Specialists report returning quality consultations, while primary care physicians report receiving them far less often. Researchers reported in Archives of Internal Medicine that perceptions of communication regarding referrals and consultations differed widely. While 69.3 percent of primary care physicians reported “always” or “most of the time” sending a patient’s history and the reason for the consultation to specialists, only 34.8 percent of specialists said they “always” or “most of the time” received the information. And, while 80.6 percent of specialists said they “always” or “most o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349515 Fri, 14 Jan 2011 18:00:00 +0100 4349515 http://www.medworm.com/index.php?rid=4331016&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffirst-report-from-the-society-of-participatory-medicines-newly-appointed-public-policy-committee-chair-david-harlow%2F2011.01.10 In December, the Society for Participatory Medicine’s executive committee appointed health law attorney David Harlow to represent the Society in public policy matters. Regular readers of HealthBlawg::David Harlow’s Health Care Law Blog know what a patient-centered, participatory thinker David is. This is his first report. I am delighted to offer my first report as Public Policy Committee Chair for the Society of Participatory Medicine. I encourage all of you who are not yet Society members to join, and I encourage new and old members to consider volunteering to help with the wide range of public policy issues facing us today. Over the past couple of months, the Public Policy Committee has gotten its sea legs. We are beginning to add the Society’s voice to the national discourse on p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4331016 Mon, 10 Jan 2011 14:00:15 +0100 4331016 http://www.medworm.com/index.php?rid=4272289&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-musical-chairs-of-medical-speciality%2F2010.12.19 The consolidation of physician specialty practices into larger corporate healthcare systems in urban areas is creating a new challenge for today’s doctors when the music stops: There might not be a chair available. There are simply many fewer hospital systems in large urban areas than there are specialy practices, so the number of specialist positions a large healthcare system is willing to absorb might be limited. As doctors and hospital systems coalesce into as-yet-to-be-clearly-defined “accountable care organizations,” the cost of too many specialists in an organization is being carefully weighed. (more…) *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4272289 Sun, 19 Dec 2010 20:00:00 +0100 4272289 http://www.medworm.com/index.php?rid=4272293&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F11-healthcare-predictions-for-2011%2F2010.12.18 Here are 11 things that are absolutely going to happen* in 2011 (they’re in no particular order….or are they?): 1.  There will be no big compromise between President Obama and the Republicans on healthcare reform. Why? Because the law is such a massive collection of, well, stuff, that it is pretty much impossible to find pieces of it that you could cut a deal on, even if you wanted to. And no, the federal district court decision on the individual mandate doesn’t change my mind…and in fact may breathe new life into other parts of the law). State governments, insurance companies, and private businesses have made all kinds of important and hard to reverse choices based on the law as is. There’s not much of an appetite outside of people trying to score political points for m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4272293 Sat, 18 Dec 2010 20:00:44 +0100 4272293 http://www.medworm.com/index.php?rid=4249056&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnewt-gingrichs-take-on-facebook-saving-a-womans-life%2F2010.12.10 I’ve seen at least half a dozen links to the op-ed coauthored by Newt Gingrich and neurosurgeon Kamal Thapar about how the doctor used information on Facebook to save a woman’s life. (It was published by AOL News. Really.) In brief, a woman who had been to see a number of different health care providers without getting a clear diagnosis showed up in an emergency room, went into a coma and nearly died. She was saved by a doctor’s review of the detailed notes she kept about her symptoms, etc., which she posted on Facebook. The story is vague on the details, but apparently her son facilitated getting the doc access to her Facebook page, and the details posted there allowed him to diagnose and treat her condition. She recovered fully. Newt and Dr. Thapar wax rhapsodic about... Better Health blogs http://www.medworm.com/rss/comments.php?id=4249056 Fri, 10 Dec 2010 23:00:54 +0100 4249056 http://www.medworm.com/index.php?rid=4203141&cid=t_368946_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F11%2Faco-arrogant-clinical-or-aggressive.html In the 1970s, it was managed care organizations.  In the 1990s, it was vertically integrated health care systems.  In the 2010s, the fashionable concept for improving health care, apparently beloved by left-wing policy wonks and right-wing health care executives is the "accountable care organization." (ACO).  Development of the ACO is funded by the recently passed US health care reform legislation.  The official definition of ACO from the US Center for Medicare and Medicaid Services is:  An Accountable Care Organization, also called an 'ACO' for short, is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program w... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4203141 Fri, 26 Nov 2010 17:51:00 +0100 4203141 http://www.medworm.com/index.php?rid=4167961&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Froadmap-for-new-physicians-how-to-avoid-fraud-and-abuse%2F2010.11.15 In October, the Office of Inspector General (OIG) issued a report on Fraud and Abuse Training in Medical Education, finding that 44 percent of medical schools reported giving some instruction in the anti-kickback statute and related laws, even though they weren’t legally required to do so. (As an aside, do we really live in such a nanny state? Over half of all medical schools don’t teach their students anything about this issue — because nobody’s making them — even though it is an issue that looms large in the practice of medicine.) On a more positive note, about two-thirds of institutions with residency programs instruct participants on the law, and 90 percent of all medical schools and training programs expressed an interest in having dsome instructional... Better Health blogs http://www.medworm.com/rss/comments.php?id=4167961 Mon, 15 Nov 2010 13:00:16 +0100 4167961 http://www.medworm.com/index.php?rid=4105669&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-healthcare-law-so-sad-its-funny%2F2010.10.25 Thanks to Scott Hensley over at Shots, NPR’s Health Blog, for highlighting this sad but funny video on where we’re going with healthcare. Scary what happens when theory meets reality: -WesMusings of a cardiologist and cardiac electrophysiologist. *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4105669 Mon, 25 Oct 2010 13:00:00 +0100 4105669 http://www.medworm.com/index.php?rid=4082093&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Facos-the-gathering-storm%2F2010.10.18 Those of you who’ve read this blog for any length of time know that I have been a pretty strong advocate for healthcare reform. This has been primarily motivated by my passion for universal coverage, but also with my frustration with the cost of the current healthcare system, the generally crummy outcomes, and the overall level of fragmentation in the whole affair. Even today, I had to repeat blood tests on a cancer patient who came to the ER. He had had blood tests at the cancer center ACROSS THE STREET before presenting, but, so sorry, our computers don’t talk to theirs and it’s after 5pm now, so forget about getting those results.  So it’s with a mixture of enthusiasm and dread that I consider the coming onslaught of accountable care organizations (ACOs). What ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4082093 Mon, 18 Oct 2010 19:00:00 +0100 4082093 http://www.medworm.com/index.php?rid=4031244&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faccountable-care-organizations-global-payments-to-replace-fee-for-service%2F2010.10.04 Federal health reform and Massachusetts health reform may find a point of convergence in the development of ACOs (accountable care organizations) and the payment mechanisms that will make them tick (or hum, or do whatever it is that we want them to do).  The Federales will be holding a listening session next week on the issues raised by ACOs across the HHS and FTC landscapes.  Meanwhile, back in Boston, the inner circle of health care regulators and the regulated community are busy hashing out an approach to global payments that could be ready for prime time by January 1. The need for payment reform in Massachusetts has been well-documented — see the health care market report from the AG’s office, as well as an earlier report on the imperative to keep insurance risk on insure... Better Health blogs http://www.medworm.com/rss/comments.php?id=4031244 Mon, 04 Oct 2010 16:00:22 +0100 4031244 http://www.medworm.com/index.php?rid=4018178&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-governments-involvement-in-new-primary-care-models%2F2010.09.30 Government healthcare reform efforts are picking up the pace to roll out new reimbursement and practice models for primary care. Medicare is giving out $10 billion for pilot projects encouraging new models of primary care, including the patient-centered medical home. New Jersey just passed legislation to explore the patient-centered medical home. Now, Massachusetts, the early adopter of mandatory health insurance, is now ambitiously planning how to take on the fee-for-service reimbursement system and moving toward accountable care organizations. Under discussion are the scope of power for state regulators, what rules will apply to accountable care organizations, and how to get rid of the existing fee-for-service system. Blogger and pediatrician Jay Parkinson, MD, MPH, comments about the &#... Better Health blogs http://www.medworm.com/rss/comments.php?id=4018178 Thu, 30 Sep 2010 12:00:00 +0100 4018178 http://www.medworm.com/index.php?rid=3889048&cid=t_368946_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fhow-oligopolists-rationalize-their.html Advocates of laissez faire commercialized health care often trumpet the advantages of competitive markets as a rationale for deregulation.  While there are theoretic, and possibly empiric reasons to think that competitive markets are the optimal way to distribute goods and services, we recently discussed aspects of health care that make it extremely hard for health care markets to be ideally competitive.  Meanwhile, two news articles gave some case-based evidence about how current health care markets are hardly competitive.   Sutter HealthA Bloomberg article focused on Sutter Health in northern and central California. Sutter Health commands a substantial part of a very large market:Sutter Health Co., the nonprofit that owns Sutter Davis, has market power that commands p... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3889048 Fri, 20 Aug 2010 20:17:00 +0100 3889048 http://www.medworm.com/index.php?rid=3641022&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-motivating-self-responsibility-in-patients%2F2010.06.07 Last week I heard a lecture about Accountable Care Organizations by a physician leader working for one of the major hospital systems. His discussion made me realize that large physician organizations and hospitals are spending lots of time solving problems of quality medical care. In my opinion quality medical care has not been adequately defined. A working definition right now is to decrease hospital stays, efficient medical care for a disease at lower cost, avoidance of medical errors in the hospital, and avoidance of hospital acquired infections. These are important goals. They must be attached to monetary incentives. Many of these problems can be solved now. The solution demands the development of processes of care. An important question is how much money will process improvement save?... Better Health blogs http://www.medworm.com/rss/comments.php?id=3641022 Mon, 07 Jun 2010 21:00:05 +0100 3641022 http://www.medworm.com/index.php?rid=3603596&cid=t_368946_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffrom-winnie-the-pooh-edward-bear-and-primary-care%2F2010.05.26 Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.  – From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.” Internists, I expect, will identify with Edward Bear. Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues. Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Monta... Better Health blogs http://www.medworm.com/rss/comments.php?id=3603596 Wed, 26 May 2010 14:00:00 +0100 3603596