Tuesday, December 30th, 2014
The 2015 Minnesota solution for managing the costs to taxpayers for 200,000 new Medicaid enrollees http://www.healthinsurance.org/minnesota-medicaid/ is the Accountable Care Organization (ACO). Here is the strategy:
1. Starve out private, independent medical practice by lowering Medicaid and Medicare fee-for-service payments, which are now below the administrative costs of maintaining most independent medical practices.
2. Survivors are large clinics: It takes organizational heft to implement mandatory (government approved) electronic medical records, hire and fire doctors on a large scale based on their “performance,” tightly control physician decision-making, endorse company “team members” with the imprimatur of the ACO organization, and lobby government to negotiate population-based “quality” reporting and terms of their payment.
3. Too big to fail:: Because the system’s survivors are getting bigger, consolidating, and collaborating, they will increasingly bargain with strength for their government capitation payments and perks. These provider organizations are so big that government will not allow them to fail financially.
4. Mitigation of medical liability risk: When bedside patient care rationing occurs by policy decree as in an ACO which requires adherence to algorithmic treatment guidelines, no individual doctor or clinic provider is (theoretically) legally responsible for medical liability suits based on deviations of medical care quality when the organization’s protocol is followed. However, since algorithmic care breaks down so regularly, expect medical liability law suits directed at the deep-pocketed ACO organizations. Look to entrepreneurial lawyers.
5. Does physician quality reporting really improve the quality of medical care? See http://www.health.state.mn.us/healthreform/measurement/adoptedrule/QualityMeasurementAppendices_101129.pdf and http://www.mnmed.org/Advocacy/Key-Issues/Quality-and-Safety/Statewide-Quality-Reporting
In 2015 Minnesotans will be recruited to join ACOs as enrollees. We’ll also be told that ACOs are key to achieving the 2010 Affordable Care Act’s (ACA) promise of expanding Medicaid enrollments while keeping costs under control.
Expect a Minnesota full court press for public support of ACOs in 2015.
Insurers in Minnesota are jumping on the ACO bandwagon. For example, Blue Cross/Blue Shield of Minnesota is teaming up with the large provider group Allina. See http://www.twincities.com/ci_21574256/blue-cross-forms-new-insurance-option-allina-health
Clinic systems and insurance companies in Minnesota are advertising ACOs. For example: Allina has a Medicare ACO http://www.allinahealth.org/Medical-Services/Clinics/Medicare-Accountable-Care-Organization-ACO/ , HealthPartners https://www.healthpartners.com/public/newsroom/newsroom-article-list/2-14-13.html , Fairview http://www.fairview.org/About/WhyChooseUs/accountablecareorganization/index.htm, public hospital-clinic HCMC http://content.healthaffairs.org/content/33/11/1975.abstract , and the State of Minnesota http://www.health.state.mn.us/healthreform/sim/
Your take on Medicaid Accountable Care Organizations: Will they live up to their promises? And, the future of private medical practices in Minnesota?
Obamacare Success: More Medicaid Enrollees; Less Medicaid
Posted on December 29, 2014 by Mark Horne — 58 Comments
http://politicaloutcast.com/2014/12/obamacare-success-medicaid-enrollees-less-medicaid/The government has arranged more Medicaid recruitment with less Medicaid reimbursement. What could go wrong? Only a zealous statist (i.e. worshiper of the state) would be so blind as to not see what is going to happen. I’m sure there are many who did see it, like Jonathan Gruber, but who are laughing to themselves about the stupid American voters. Sadly, the term “zealous statist” applies to all the major media networks, Democrats, many Republicans, and 99.9 percent of politicians Read more [...]