Tag Archives: ACO

Health Policy Updates: August 27 2016

There was a new study out this week in JAMA Internal Medicine assessing the impact of Accountable Care Organization on health care spending. The ACO model of reimbursement, with the ACA/Obamacare has supported the growth of, is a form of capitation. The idea is that if health systems get paid for the overall care of each patient but not for each additional test it performs, then the financial incentive to order more tests will decrease, as will overall spending.

That is indeed what this study found, though the effect was modest – about $136 per patient per year. Continue reading Health Policy Updates: August 27 2016

Health Policy Updates: June 25 2016

A new study published in JAMA Internal Medicine this week had some surprising findings relating to gifts to physicians from pharmaceutical companies. The authors asked whether physicians who received a free meal from a drug company were more likely to prescribe expensive, brand-name medications produced by that company. The answer – surprisingly or not – was “yes.” And, it remained “yes” even for single meals less that $20 in value (though the association tended to be higher for more and/or more expensive meals). This study has obvious implications regarding the ethics of physician-industry financial relationships.

The differences persisted after controlling for prescribing volume and potential confounders such as physician specialty, practice setting, and demographic characteristics. Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug. Our findings were consistent across 4 brand-name drugs, including rosuvastatin…” Continue reading Health Policy Updates: June 25 2016

Health Policy Updates: September 19 2015

Growth in health care spending, low for the past several years for reasons that are still unclear, has been increasing again. This is reflected in a new projection of health care spending over the next decade.

“Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase.” Continue reading Health Policy Updates: September 19 2015

Health Policy Updates: July 5 2015

News this week on the progress of ACOs, a new payment model that the ACA is experimenting with. The idea is that health care providers makes something like a flat rate for taking care of a given set of patients. If they do so for less money than expected, they get to keep the difference; if they spend too much, then they lose money. Obviously, the goal here is to cut health care costs by moving away from the fee-for-service payment model that incentivizes increased spending. Several ACOs have been up and running, and results on their performance are starting to come in.

Austin Frakt at TheUpshot reports on two recent studies here. Continue reading Health Policy Updates: July 5 2015

Health Policy Updates: May 17 2014

I was really excited to discover the following website, a treasure trove of health-policy related lectures! Some of them are by politicians (which I have been ignoring), but many of the others are actually educational. Go check it out!
 
A recently published paper has uncovered some potential problems with accountable care organizations – basically, that patients move in and out of ACOs too fast for the organization to really have the (intended) incentive to hold down patient costs over time:
These aren’t problems to be ignored. These are the kind of problems that will sink the ACO experiment. How do you manage patients’ long-term care more efficiently if you don’t keep them year-to-year? How do you prevent them from over-utilizing care if they just go somewhere else to get it when you try?”
Should the ACA drop the employer mandate (ie, the requirement that companies with more than 50 employees provide health insurance to its employees)? A new research paper from the Urban Institute seems to suggest so. See the discussion on Vox.com here:
http://www.vox.com/2014/5/10/5700536/should-obamacare-let-employers-not-provide-insurance
And a discussion on JAMA here:
http://newsatjama.jama.com/2014/05/14/jama-forum-time-to-reconsider-the-acas-employer-mandate/
(I would be all for removing the requirement…less because of the numbers that the Urban Institute produced, and more because linking insurance to employment is generally a pretty bad way to do things. If you are curious about that, more here: http://economix.blogs.nytimes.com/2009/05/22/is-employer-based-health-insurance-worth-saving/)

 

A recent JAMA IM paper gave some recommendations for better reporting of health news. You may recognize some of the basic principles from Dr Zipkin’s and Dr. Simel’s EBM lectures!
http://www.vox.com/2014/5/13/5713286/how-to-tell-if-that-health-medical-story-is-hogwash
hat tip to Josh Briscoe

A discussion of the data on expanded roles for nurse practicioners, which we doctors tend to be resistant to:
http://theincidentaleconomist.com/wordpress/if-physicians-outperform-nurses-at-primary-care-the-evidence-doesnt-show-it/
Compared to physicians, NPs provide a similar, or better, quality of care; are a more agile and flexible workforce to deploy, taking a fraction of the time to train; earn less; and the preponderance of evidence indicates they are able to provide care more cheaply.”