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'. Sat, 03 Sep 2011 02:19:09 +0100 http://www.medworm.com/index.php?rid=5181798&cid=t_395909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-features-of-a-bundled-payment-for-care-improvement-project%2F2011.09.01 Many health care provider organizations have not been overly eager to jump onto the Accountable Care Organization (ACO) bandwagon, citing high startup costs and uncertain returns on investment given the complexity of the program.  Well, recently, the CMS Center for Innovation has announced the Bundled Payment for Care Improvement initiative.  This initiative incorporates elements of earlier CMS demonstration projects — the gainsharing demos and ACE (acute care episode) bundled payments demonstrations which the HealthBlawger has helped a number of clients around the country qualify for in the past — and builds on the broad authority granted to the CMS Center for Innovation under health reform. The advantages to proceeding with a Bundled Payment for Care Improvement project inc... Better Health blogs http://www.medworm.com/rss/comments.php?id=5181798 Thu, 01 Sep 2011 21:00:08 +0100 5181798 http://www.medworm.com/index.php?rid=5159351&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FdflHJn4aeTM%2Fbundled-payments-for-care-improvement-initiative-announced-by-cms-center-for-innovation.html Many health care provider organizations have not been overly eager to jump onto the Accountable Care Organization (ACO) bandwagon, citing high startup costs and uncertain returns on investment given the complexity of the program.  Well, recently, the CMS Center for Innovation has announced the Bundled Payment for Care Improvement initiative.  This initiative incorporates elements of earlier CMS demonstration projects -- the gainsharing demos and ACE (acute care episode) bundled payments demonstrations which the HealthBlawger has helped a number of clients around the country qualify for in the past -- and builds on the broad authority granted to the CMS Center for Innovation under health reform. The advantages to proceeding with a Bundled Payment for Care Improvement project include the... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=5159351 Thu, 25 Aug 2011 11:17:08 +0100 5159351 http://www.medworm.com/index.php?rid=5130872&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FX8JuuH6We8U%2Fpartners-health-care-acquiring-neighborhood-health-plan-the-800-pound-gorilla-and-the-fig-leaf.html Partners Health Care (the dominant provider network in Greater Boston) and Neighborhood Health Plan (a local mostly-Medicaid HMO) just announced that the former intends to acquire the latter, and maintain it as a separate operating entity.  No money will change hands between the parties, but an unspecified amount of money will be given by Partners as grants to community health centers where NHP members receive much of their health care services. Gary Gottlieb, CEO of Partners, graciously allowed that it would not seek to interfere with the current referral patterns of NHP members to the two local safety-net hospitals (which get disproportionate share hospital payments; Partners hospitals do not). The deal is contingent on several layers of regulatory review, including review by the Commo... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=5130872 Sun, 14 Aug 2011 20:35:15 +0100 5130872 http://www.medworm.com/index.php?rid=5125824&cid=t_395909_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_395909_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=5050811&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FtS3SgTYmYeY%2F by Vince Kuraitis JD, MBA and Jaan Sidorov MD, MHSA, FACP In our introductory posting of this series, we noted that economic incentives previously aligning doctor-hospital interests were changing. This creates the potential for The 100 Year Shift – physicians awakening to possibilities for stronger partnerships with payers than with hospitals. In this post, we will zero in on the changing economic position of hospitals and the effect this is having on physician-hospital relationships. We will examine the trend of hospital employment of physicians and point out challenges and tensions for the future. [This is a long post...so now might be the time to refill your coffee cup.] (more…) Article Series - The 100 Year Shift? Strategic Realignment among Physicians, Hospitals and Payer... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=5050811 Tue, 19 Jul 2011 19:28:14 +0100 5050811 http://www.medworm.com/index.php?rid=5008372&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FXIWnixTJ1Vs%2F by Jaan Sidorov MD, MHSA, FACP and Vince Kuraitis JD, MBA In our introductory posting, we suggested that a huge shift is underway in the health care industry.  Decades of hospital-physician cooperation are not only eroding, we suggest this trend could accelerate.  Instead of a natural clinical and economic affinity with hospitals, we foresee the potential for physicians forming a new dyad with insurer-buyers. In this post, we will examine what we and many other commentators view as inevitable: the demise of volume-based payment systems and how the drive for greater value will cause physicians and insurers re-examine their normally antagonistic relationship. (more…) Article Series - The 100 Year Shift? Strategic Realignment among Physicians, Hospitals and PayersThe 100 Year Shift?... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=5008372 Thu, 07 Jul 2011 20:42:41 +0100 5008372 http://www.medworm.com/index.php?rid=5008415&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Fhealthblawg.typepad.com%2Ffiles%2Fregina-herzlinger-on-healthblawg-w-david-harlow-07-2011.mp3 I spoke with Harvard Business School professor Regina Herzlinger this week about health reform – the good, the bad and the ugly – touching on ACOs and demonstration projects under the Affordable Care Act; innovations coming down the pike in the private sector either because of the law or because of market forces; social media in health care; and two key fixes to the ACA that she believes are absolutely necessary in order to make it work, or work as best it can. First of all, she expressed her delight at the passage of a federal law nudging us ever closer to universal coverage, combined with dismay at its failure to address rising costs (noting that we're looking at policies yielding an accumulated Medicare deficit of $90 trillion, as compared to an annual GDP of $12-14 trillion) and a... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=5008415 Thu, 07 Jul 2011 15:39:44 +0100 5008415 http://www.medworm.com/index.php?rid=4975988&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FKNUpsAvSVXc%2F A study released last week by the Massachusetts Attorney General contains surprising data to challenge two commonly held ACO (accountable care organization) ”Field of Dreams” assumptions. These assumptions relate to patient ”leakage” — out-of-network patient care and referrals. 1) Hospital administrators assume that tighter physician-hospital integration (e.g., through employment of physicians) will result in ”captive referrals” by physicians back to the mother-ship hospital. 2) Medicare administrators are assuming that Medicare Shared Savings ACOs will be able to coordinate patient care even without limitations on patients’ choice to go to providers outside of the ACO provider network. Here’s the data that challenges the validity of ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4975988 Mon, 27 Jun 2011 18:21:41 +0100 4975988 http://www.medworm.com/index.php?rid=4968661&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2Fxx0GnFs4A0k%2Fmassachusetts-healthcare-reform-experiment-analyzed-attoney-general-martha-coakley-are-we-ready-for-global-payment-.html Massachusetts Attorney General Martha Coakley released her office's second annual report, An Examination of Health Care Cost Trends and Drivers (PDF; see also press release), which contains a wealth of critical data analysis -- and also highlights how little we know about certain things -- providing some important context for the discussion of the proposed Part III of Massachusetts health reform, a bill filed by Governor Patrick which would create all-payor ACOs and a system of global payments. At this late date, few would argue against a move a way from fee-for-service reimbursement for health care, or adding quality metrics to the mix, and tying financial rewards to providers to their performance measured against these metrics.  (Consider the Massachusetts Blue Cross Blue Shield ACQ (a... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4968661 Fri, 24 Jun 2011 17:50:55 +0100 4968661 http://www.medworm.com/index.php?rid=4968662&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FJsCTlY3xPP4%2Fspeaking-engagements-health-care-social-media-acos-and-more.html I spoke recently at a MassMEDIC conference about the FDA and social media, and on a webinar presented by the Mayo Clinic Center for Social Media (with which I am associated, as a member of its external advisory board) and Ragan Communications, and I will be speaking at a number of upcoming conferences.  It occurred to me that it would be worthwhile to share information about these events for those who may be interested. Feedback I've received from some program participants is that topics covered in an hour-long session on health care social media sometimes get short shrift.  For those who may be interested in more in-depth treatment of some issues, I'll call to your attention the webinar series to be held in mid-July (four hours over two days).  Let us know about any particular areas o... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4968662 Thu, 23 Jun 2011 04:58:49 +0100 4968662 http://www.medworm.com/index.php?rid=4934435&cid=t_395909_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=4893643&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2F2B2X0b39ekw%2Faco-pgp-demonstration-cms-dont-kick-a-unicorn-when-its-down.html There has been a significant outcry against the proposed ACO regs: everything's wrong and nothing's right about them, or so some would have us believe.  (The comment period is still open, and CMS is still soliciting input; much of the outcry is a form of posturing and negotiation ... not that there's anything wrong with that.) Today's "nattering nabobs of negativism" focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure incuded), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, the premature pledging of allegiance to an idea only partly proven through the PGP demo, the likelihood of failure due to the whole endeavor's being tied to FFS reimbursement, on the one hand, and due to... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4893643 Fri, 03 Jun 2011 12:40:18 +0100 4893643 http://www.medworm.com/index.php?rid=4883724&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2Fm16_TJ37BMQ%2Fonc-federal-health-it-strategic-plan-comments-filed-on-behalf-of-the-society-for-participatory-medic.html We e-patients are an impatient lot, and therefore we may not be big fans of the Five-Year Plan approach to creating change.  The Office of the National Coordinator for Health IT released a draft federal health IT strategic plan in late March, via blog post (the plan itself is linked to from the post; a copy is posted here). The ONC post says: The Plan demonstrates how we will build off the foundation of meaningful use to unlock the power of information to: Enhance our ability to study care delivery and payment systems Empower individuals to improve and participate more in their care Improve care, efficiency, and population health outcomes, through tools such as clinical decision support, real- time feedback of performance to clinicians, and targeted public health campaigns The... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4883724 Tue, 31 May 2011 14:01:00 +0100 4883724 http://www.medworm.com/index.php?rid=4841690&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FFtmKA-h810c%2Fis-the-aco-doa-reasonable-minds-can-improve-the-draft-regulations.html In the current all-ACO, all the time, health care policy news cycle, we've been inundated with declarations that the ACO is dead, because a handful of big boys say they don't want to play. Today, CMS announced that it is... Read the full post on HealthBlawg. (Source: HealthBlawg :: David Harlow's Health Care Law Blog) HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4841690 Tue, 17 May 2011 19:35:33 +0100 4841690 http://www.medworm.com/index.php?rid=4820955&cid=t_395909_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_395909_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_395909_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_395909_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=4789633&cid=t_395909_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2Frn2r9MWhDMo%2F Conceived as part of health care reform, accountable care organizations may become the next big thing in lowering cost. The basic premise involves a network of doctors and hospitals that share responsibility for providing care to patients. Each ACO would receive financial incentives to provide quality care to Medicare beneficiaries while holding down costs. And since the intiative is scheduled to launch in January 2012, there is a scramble under way among physician practices and hospitals to form ACOs. The Obama administration, meanwhile, recently proposed guidelines on how ACOs will work (look here). But what are the implications for the pharmaceutical industry? We spoke with Ian Spatz, a senior advisor to Manatt Health Solutions, founder of Rock Creek Policy Group and a former vp for pub... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4789633 Thu, 05 May 2011 20:50:41 +0100 4789633 http://www.medworm.com/index.php?rid=4780312&cid=t_395909_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_395909_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_395909_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=4734087&cid=t_395909_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FSmas1Bps-RU%2F This post was co-authored by Disruptive Woman Archelle Georgiou and Emma Dougherty, Senior Analyst at TripleTree and originally published on the firms blog site, Uncommon Clarity. It was also posted on Archelle on Health. 9 million. That’s how many web hits are returned during a Google search for “Accountable Care Organization,” and reflects the countless articles, white papers and opinions that have been published regarding the potential successes and more likely pitfalls of the proposed ACO mandate. As highlighted in TripleTree’s recent post, our team is continuously evaluating the business development opportunities being fueled by the demands and requirements of these new provider organizations.  Last week, the members of our Healthcare Executive Roundtable recently discuss... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4734087 Wed, 20 Apr 2011 13:33:32 +0100 4734087 http://www.medworm.com/index.php?rid=4709203&cid=t_395909_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_395909_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_395909_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=4684482&cid=t_395909_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2F4a7BPdYBVDY%2F John’s Note: The following is a guest post by Mark Segal talking about the recently announced ACO program and it’s relationship to EHR, meaningful use, and healthcare IT. I also love the insider look at rule making. The long-awaited proposed rule on Medicare’s Shared Savings Program (SSP)/Accountable Care Organization (ACO) program is out. These 429 pages outline how the Administration plans to transform U.S. health care delivery from fee-for-service to a value-based emphasis on accountability for quality and efficiency of care provided for populations. Following a final rule later this year, the program is to start January 1, 2012, with additional January 1 annual starts by ACOs, and a special optional start possible for July 1, 2012 given the tight timing this year. CMS so... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4684482 Tue, 05 Apr 2011 17:21:54 +0100 4684482 http://www.medworm.com/index.php?rid=4676902&cid=t_395909_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=4670203&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FEuBxzB-YbdY%2Faccountable-care-organization-aco-regulations-first-look.html 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 (@health... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4670203 Sun, 03 Apr 2011 14:07:31 +0100 4670203 http://www.medworm.com/index.php?rid=4664312&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FwCXPiE0r0eI%2Faccountable-care-organization-proposed-regulations-released-for-public-comment.html The long-awaited ACO regulations were released by CMS in draft form today, accompanied by a series of conference calls for different constituencies.  Here is a mirrored copy: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations - Proposed rule. // <![CDATA[ // <![CDATA[ // <![CDATA[ // <![CDATA[ // <![CDATA[ // <![CDATA[ // <![CDATA[ // <![CDATA[ // <![CDATA[ (function() { var scribd = document.createElement("script"); scribd.type = "text/javascript&... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4664312 Fri, 01 Apr 2011 07:10:32 +0100 4664312 http://www.medworm.com/index.php?rid=4631477&cid=t_395909_87_f&fid=38368&url=http%3A%2F%2Fdocs.house.gov%2Fenergycommerce%2Fppacacon.pdf The following is a guest post by Nicole Sweeny, originally posted on Policy Mic on March 22nd. By Nicole Sweeny. In October 2010, seven months after the passage of health reform, hundreds of health care industry stakeholders gathered in an overcrowded conference room at the Centers for Medicare & Medicaid Services. They were all eagerly waiting to give their input on one of the most buzzworthy provisions of health reform: the Accountable Care Organization. Implemented by Section 3022 of the Patient Protection and Affordable Care Act, Accountable Care Organizations, or “ACOs,” are vaguely defined as groups of providers that will manage all aspects of care for the Medicare beneficiaries assigned to them (seniors over the age of 65 are eligible for Medicare). ACOs will have to meet q... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4631477 Thu, 24 Mar 2011 12:45:51 +0100 4631477 http://www.medworm.com/index.php?rid=4610871&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FSjXt2mNST7s%2F While in Philadelphia earlier this week, my colleague Dr. David Nace presented me with a print copy of McKesson Relay Health’s newest whitepaper — Providing Accountability: Accountable Care Concepts for Providers.  I felt honored as he handed it to me and confided that it was one of only six copies in print.  I took time to read it carefully on the long flight home. The whitepaper is a great overview of accountable care and ACOs (Accountable Care Organizations). It’s a quick and easily digestible read. However, there is one key point articulated in the paper that I’d like to emphasize here: accountable care is not synonymous with ACOs. (more…) Article Series - Accountable Care Organizations: Cure-du-Jour or Real Collaborative Care?The Big Idea in U... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4610871 Fri, 18 Mar 2011 18:25:39 +0100 4610871 http://www.medworm.com/index.php?rid=4592493&cid=t_395909_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_395909_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=4532332&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FbC1QuIaSDxA%2Fputting-patients-into-menaningful-use-regulators-and-providers-are-catching-up-with-e-patients.html The Health Research Institute at PricewaterhouseCoopers released a report last week entitled Putting patients into "meaningful use." It begins with the anecdote I've blogged about previously regarding a diagnosis by Facebook in lieu of a PHR, which some have highlighted as a great success for social media in health care. I am much less sanguine on that front. The PwC report, of course, has much more than that story in it; here are the key takeaways, backed up with some survey data and interviews: Engaging external constituents may postpone achievement of "meaningful use." Patient awareness of and access to available health IT tools is low; social, expectation, and education hurdles also exist. Patient engagement in "meaningful use" is still low, despite consumer interest. "Meaningful ... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4532332 Tue, 01 Mar 2011 15:40:00 +0100 4532332 http://www.medworm.com/index.php?rid=4545031&cid=t_395909_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_395909_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=4489784&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FszZjnknpMYs%2Fmassachusetts-health-reform-part-iii.html Today, Massachusetts Governor Deval Patrick filed health care reform legislation that, if enacted, will take the Commonwealth to the next level, taking the third step in the process that began in 2006 with the universal coverage law, and continued in 2008 with the legislation directed at containing cost and improving quality.  One of the provisions of the 2008 law established a special commission on the health care payment system that shall investigate reforming and restructuring the system to provide incentives for efficient and effective patient-centered care and to reduce variations in the quality and cost of care. The 2009 report of the special commission on the health care payment system was followed in 2010 by a report by the Office of the Attorney General and legislative hearin... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4489784 Fri, 18 Feb 2011 04:11:34 +0100 4489784 http://www.medworm.com/index.php?rid=4477761&cid=t_395909_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=4477885&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2Ffo8JZajtT1I%2Faqc-to-aco-as-goes-massachusetts-so-goes-the-nation.html About four years ago here in Beantown, survivors of the last big ill-conceived or poorly-executed (depends who you ask) wave of health care management and finance innovation were kicking around for a new approach to aligning payor and provider incentives, focusing on quality and cost containment. To hear Andrew Dreyfus, CEO of Blue Cross Blue Shield of Massachusetts, tell the story, the Blues wanted to address both quality and cost, and therefore (after looking in vain for a model elsewhere that could be transplanted to Massachusetts) developed the Alternative Quality Contract, or AQC, which features a global payment model hybridized with substantial performance incentives, plus design features intended to lower the cost of care over time. Many of the features put in place under the AQC w... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4477885 Mon, 14 Feb 2011 14:38:45 +0100 4477885 http://www.medworm.com/index.php?rid=4455262&cid=t_395909_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_395909_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_395909_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_395909_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_395909_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=4318410&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FTUSQTN0muO8%2Faccountable-care-organizations-the-emperor-has-no-clothes-or-jeff-goldsmiths-plan-b.html The current all-ACO issue of Health Affairs includes a piece by Jeff Goldsmith entitled: Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers.  It is a proposal for how private sector health plans ought to pay for services, in order to save us all from what Goldsmith sees happening in the near future thanks to the Gold Rush mentality among health care provider organizations working to become ACOs before they've been defined in regulation.  He begins with a précis of how we've gotten into the health care market mess we're in, touching on the concentration of market power in horizontally and vertically integrated health care provider organizations, payors and providers mudwrestling over fee-for-service reimbursement rates, and the rise of ... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4318410 Thu, 06 Jan 2011 13:28:38 +0100 4318410 http://www.medworm.com/index.php?rid=4272289&cid=t_395909_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_395909_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=4265923&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FMJs5VvLnXPs%2F Will ACO (accountable care organization) IT models be walled gardens or open platforms?  i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network? (If the question still isn’t clear, click here for a further explanation.). (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 Ga... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4265923 Thu, 16 Dec 2010 00:45:16 +0100 4265923 http://www.medworm.com/index.php?rid=4249056&cid=t_395909_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=4249120&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2F1KbmMbio8qk%2Ffacebook-saves-womans-life-newt-gingrich-and-reality-based-healthcare-systems-planning.html 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 how Facebo... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4249120 Fri, 10 Dec 2010 14:29:54 +0100 4249120 http://www.medworm.com/index.php?rid=4203141&cid=t_395909_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=4190287&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2Fes001VGqoHg%2Fhealth-care-reform-what-price-progress-1.html There's a lot of breast-beating going on out there regarding recent "shocking" behavior by many health care provider organizations.  Believe it or not, all across the nation, health care providers are seeking to affiliate/acquire/be acquired in the hopes of creating more efficient, more comprehensive provider networks, which can survive and flourish under new reimbursement regimes designed to squeeze inefficiencies out of the system in an effort to achieve the much-vaunted triple aim of providing high quality health care to ensure population health at a reasonable cost.  This thread was picked up in Robert Pear's Sunday New York Times piece, Consumer Risks Feared as Health Law Spurs Mergers, which focuses on concerns that prices will go up as health care providers consolidate and gain g... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4190287 Mon, 22 Nov 2010 17:50:04 +0100 4190287 http://www.medworm.com/index.php?rid=4183385&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2F5yuEUj5711I%2Fdavid-harlow-keynotes-on-health-care-social-media-and-the-law-at-annual-healthcare-and-the-internet-.html I attended the 14th Annual Healthcare and the Internet Conference in Las Vegas this week, and gave a keynote presentation entitled: "Health Care Social Media - The Lawyers Don't Always Say No" in which I discussed the reasons for health care providers to engage with their constituencies via social media -- both from a business perspective and from a regulatory perspective (ACO rules and future phases of Meaningful Use rules effectively demand a response from providers involving social media), and how to do it without getting into trouble (there are a variety of HIPAA, other privacy, liability, anti-kickback and fraud and abuse issues to keep in mind when planning for patient engagement through social media). Here are the slides from my talk: Health Care Social Media - The Lawyers Don't Al... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4183385 Fri, 19 Nov 2010 16:53:27 +0100 4183385 http://www.medworm.com/index.php?rid=4167961&cid=t_395909_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=4151980&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2F33NVHEUOWTA%2Foig-issues-roadmap-for-new-physicians-a-guide-to-avoiding-fraud-and-abuse.html In October, the Office of Inspector General issued a report on Fraud and Abuse Training in Medical Education, finding that 44% 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 2/3 of institutions with residency programs instruct participants on the law, and 90% of all medical schools and training programs expressed an interest in having dsome instructional materials on the subject of the anti-kickback statute, p... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4151980 Mon, 08 Nov 2010 14:33:16 +0100 4151980 http://www.medworm.com/index.php?rid=4125106&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FiVKcHAfiCcc%2F The American College of Physicians (ACP) just released a well-reasoned and thorough position paper, The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices. As I’ve written before, the Big Idea behind ACOs (Accountable Care Organizations) is the notion of accountability, not the specifics of organizational structure. The purpose of the ACP position paper is to address the gaps that exist in care coordination when a physician refers a patient to a specialist. The obvious and logical answer proposed is to develop “Care Coordination Agreements” between primary care physicians and referring specialists, and the position paper takes 35 pages to explain why and how. A simplified way of thinking about Care... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4125106 Mon, 01 Nov 2010 17:28:08 +0100 4125106 http://www.medworm.com/index.php?rid=4119222&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FGlM8uPW2xxE%2Fdavid-harlow-will-be-a-keynote-speaker-at-the-14th-healthcare-internet-conference-november-15-17-in-.html I will be speaking on the legal issues surrounding health care social media at the upcoming 14th Annual Healthcare Internet Conference.  Some health care executives are concerned that involvement with social media on behalf of their organizations can lead only to ruin: HIPAA and malpractice liability, employment issues and other concerns lead many providers to ignore social media entirely.  Well, as I'll be explaining at the conference, the lawyers don't always say no, and there are a number of good reasons to get involved.  Health care providers that do not have a social media presence (yet) should all begin to monitor online channels, including social media channels, to learn what is being said about them -- so that they can begin to respond in real life (IRL).  Before jumping into ... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4119222 Fri, 29 Oct 2010 15:02:46 +0100 4119222 http://www.medworm.com/index.php?rid=4105816&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FoWmt5JQ5BeI%2Fconnected-health-symposium-2010.html I attended the Connected Health Symposium last week in Boston. I enjoyed many of the sessions (sometimes wished I could have attended two simultaneously, though the livetweeting helped on that front), and as usual enjoyed the hallway and exhibit floor conversations too.  As is often the case at conferences these days, I had the opportunity to meet several on-line connections in real life for the first time.  (I will not attempt to give a comprehensive report of the symposium here; please see the livetweeting archive linked to above and other reports to get a sense of the rest of the event.) This year's exhibit floor included a diverse mix of distance health tools.  Most striking from my perspective was the fact that most of these tools do one of two things: Enable patient-clinician vi... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4105816 Mon, 25 Oct 2010 16:41:01 +0100 4105816 http://www.medworm.com/index.php?rid=4105669&cid=t_395909_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_395909_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=4036757&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2FO_O0GBSLJWs%2F Kudos to the AMGA (American Medical Group Association) for advancing the cause of physician-led accountable care organizations (ACOs)! A few days ago it “convened leadership teams from 22 leading medical groups and organized systems of care at the inaugural meeting of the AMGA ACO Development Collaborative”. In many communities, hospitals (delivery systems) will be the “natural” organization to lead an ACO. Hospitals bring management expertise, IT, capital, and community relationships to the table as important assets. Questions about Hospital-Led ACOs I’ll try to keep an open mind, but I question whether hospitals are best positioned to lead ACOs: (more…) Article Series - Accountable Care Organizations: Cure-du-Jour or Real Collaborative Care?The Achilles Heel of... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4036757 Wed, 06 Oct 2010 19:37:55 +0100 4036757 http://www.medworm.com/index.php?rid=4036772&cid=t_395909_114_f&fid=34648&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHealthBlawg%2F%7E3%2FmSY0Ec6RZEE%2Faco-workshop-the-feds-commit-to-making-accountable-care-organizations-work-with-safe-harbors-waivers.html Don Berwick kicked off the day-long Accountable Care Organization (ACO) Workshop and Listening Session, co-hosted by the FTC, CMS and the OIG, with a short, stirring speech that touched on his Triple Aim for health care: better care for individuals, better health for populations and reduced per-capita costs.  He committed the government to interpreting applicable statutes "wisely, so as not to impede the development of ACOs."  That sums up the reason this workshop was so eagerly anticipated.  Health care providers are extremely eager to become ACOs - though the term has yet to be fully defined - yet are extremely concerned about the potential to have specific ACO arrangements identified as illegal by the FTC, the OIG or CMS because the arrangements violate antitrust law, Stark, anti-kic... HealthBlawg :: David Harlow's Health Care Law Blog blogs http://www.medworm.com/rss/comments.php?id=4036772 Wed, 06 Oct 2010 04:16:06 +0100 4036772 http://www.medworm.com/index.php?rid=4031244&cid=t_395909_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=4027237&cid=t_395909_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2Fi64TWB_EG3E%2F Sometimes you read something and the full impact doesn’t hit you until hours — perhaps days — later.  As I was out mountain biking today, the importance of something I ran across yesterday suddenly hit me. Accountable Care Organizations (ACOs) are today’s cure-du-jour for reforming the health care delivery system. Bob Berensen, MD of the Urban Institute strongly questions whether the shared savings model under current legislation provides enough economic incentive for hospitals to disrupt their existing core business of acute, inpatient care. The dialogue took place at HSC’s 15th Annual Wall Street Comes to Washington Conference. Here’s the conversation from the transcript — I actually went back to dig this out of my trash: Paul Ginsburg: Actually, let me ... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4027237 Sun, 03 Oct 2010 22:16:40 +0100 4027237 http://www.medworm.com/index.php?rid=4018178&cid=t_395909_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_395909_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=3807535&cid=t_395909_180_f&fid=38607&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fsuccessbeginstoday%2FBHWQ%2F%7E3%2Fzy5H3zH_ikU%2F In my last post, I talked about creating a document to track our progress on a long term goal using the FAST method which includes… 1. Focused work means working on one thing at a time. You turn off all distractions such as e-mail, web browsers, and close your door if possible, and focus on one key task. 2. Accountable means setting a short term and long term goal for your project and letting someone else hold you accountable for completing the task. 3. Scheduled means setting a time and place for your focused activities and also setting a completion schedule with milestones along the way. 4. Time is the amount of focused time you will spend on each interval of the project and also the amount of days or weeks to complete the project. Looking at our objectives above, we’ll need to incl... Success Begins Today blogs http://www.medworm.com/rss/comments.php?id=3807535 Fri, 30 Jul 2010 14:01:33 +0100 3807535 http://www.medworm.com/index.php?rid=3641022&cid=t_395909_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_395909_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