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Even more Obamacare success

Yep. You can keep your current doctor iff they are willing to accept "new models of reimbursement" under PPACA.
 
To prepare for healthcare reform, Cleveland Clinic is transforming the way care is delivered to patients. Over the past several years, we have had an ongoing focus on driving efficiencies, lowering costs, reducing duplication in services and enhancing quality to make healthcare affordable to patients.

Indeed, the point of reform is to lower costs and improve quality. Turning a bloated sector into an efficient one that delivers a better product. Sounds like it's working.

The Cleveland Clinic has always been a good example of the rhetoric vs. reality on the ACA's payment and delivery reforms (the "it doesn't control costs!" rhetoric vs. the reality that, oh wait, it does).

For instance, the Cleveland Clinic's CEO, Toby Cosgrove, offered some of the rhetoric in the pages of the WSJ in the summer of 2012:
Cosgrove also said the health care law, which was recently upheld by the U.S. Supreme Court, doesn't control costs or contain many incentives for people to take care of themselves.

But by the time he gave an interview to the WSJ last December, he let the reality slip in a bit:
WSJ: How does the health overhaul affect you?

Dr. Cosgrove: We knew that we had to reduce costs and we had to drive a more efficient health-care delivery system. [The law] just gave additional impetus to get that done.

An "impetus" for major groups of hospitals and doctors to cut costs sure, "controlling costs" absolutely not!
 
Indeed, the point of reform is to lower costs and improve quality. Turning a bloated sector into an efficient one that delivers a better product. Sounds like it's working.

The Cleveland Clinic has always been a good example of the rhetoric vs. reality on the ACA's payment and delivery reforms (the "it doesn't control costs!" rhetoric vs. the reality that, oh wait, it does).

For instance, the Cleveland Clinic's CEO, Toby Cosgrove, offered some of the rhetoric in the pages of the WSJ in the summer of 2012:


But by the time he gave an interview to the WSJ last December, he let the reality slip in a bit:


An "impetus" for major groups of hospitals and doctors to cut costs sure, "controlling costs" absolutely not!

It is how the costs are lowered by PPACA that make the difference. The cost savings are achieved by simply lowereing the reimbursement rates offered to care providers (doctors/clinics) under Medicare and Medicaid/CHIP (which is also expanded under PPACA).

Medicare reimbursement cuts threaten access to care

Lower than expected Medicare reimbursement rate will leave hospitals feeling the pain - Winston-Salem Journal: Local

The law creates an entity known as the Independent Payment Advisory Board (IPAB). The group will make recommendations to Congress about Medicare physician payment levels if the growth of Medicare spending gets too far ahead of inflation. The recommendations will automatically go into effect unless Congress votes to rein in spending another way.

Read more: The Secretive Group Behind Medicare Reimbursements | TIME.com
 
It is how the costs are lowered by PPACA that make the difference. The cost savings are achieved by simply lowereing the reimbursement rates offered under Medicare and Medicaid/CHIP (which is also expanded under PPACA).

The federal government (and state governments, too, since they're also working on this) is a payer, meaning the leverage it has to reform health care is payment policy. But the goal of changing payment policy is to prompt providers to redesign the delivery of care to make it better coordinated and more efficient and to deliver a better product. In other words, reward them for better care, make it financially feasible and desirable to offer better care more efficiently, and if necessary offer them some technical assistance to help them figure out how to make those changes. Then watch as they redesign what they do to produce better results more cheaply. This is what the Cleveland Clinic is doing. Yes, it's in response to payment policy, which is the reason those policies were instituted in the first place. To change behavior and produce better care.

The ACA has launched a number of payment reform experiments for providers who want to try them out and they're showing promise:

Obamacare-like groups may produce 'spillover' savings
(Reuters Health) - A program focused on primary care and coordination of services between groups of doctors and hospitals reduced costs for patients who were not even covered by the plan, according to a new study.

Obamacare Shows Hospital Savings as Patients Make Gains
Less than five months before the Affordable Care Act fully kicks in, hospitals are improving care and saving millions of dollars with one of the least touted but potentially most effective provisions of the law. . .

Under the program, hospitals and physician practices take responsibility for tracking and maintaining the health of elderly and disabled patients. If costs rise beyond an agreed upon level, hospitals may become responsible for reimbursing the government. If they cut the cost of care while maintaining quality, hospitals share in the savings. The government expects the savings may be as much as $1.9 billion from 2012 to 2015. Early indications suggest they are starting to add up.

Obamacare pilot project lowers Medicare costs
An ambitious program under the health law to change how care is paid for lost nearly a third of its participants after the first year, but not before all were able to boost the quality of care provided to patients in an experiment that some experts say holds promise to bring down health care costs in the long run.

The Centers for Medicare & Medicaid Services announced Tuesday that all 32 health care organizations had hit performance benchmarks for improving care in the Pioneer Accountable Care Organization program, and 13 had done so while substantially lowering Medicare costs. In part, that was by reducing hospitalization and rehospitalizations, CMS reported.

But at a larger level, the law calls for reimbursement increases to providers across the Medicare program (except physicians under the Part B fee schedule) to slow over this decade. The idea is that this provides the impetus (in Cosgrove's own words!), along with the help provided by new payment model opportunities and other assistance in the law, to reform the delivery of health care to make it better and less costly. And if the Cleveland Clinic is any indication, it's already starting to work.

Anyway, this NEJM perspective from March 2012 lays out the rationale for cuts to spur progress: Slower Growth in Medicare Spending — Is This the New Normal?
In site visits and interviews conducted for our ongoing qualitative research, the Center for Studying Health System Change found strong provider interest in payment reform and efforts to prepare for it, with the prospect of increasing constraint on Medicare payment rates cited as motivation. We see a combination of reformed delivery of care and broader units of payment as having the potential to allow providers to generate savings through steps that are less threatening to quality of care and access than are cuts in payment rates. More concretely, payment on the basis of shared savings or partial capitation can reward providers for delivering care more efficiently. This approach is preferable to merely paying providers less and less for business as usual.

There is a historical precedent for harsh, simple-minded cuts setting the stage for broad-based payment reform. Up until the early 1980s, Medicare reimbursed hospitals for costs incurred, subject to ceilings. The Tax Equity and Fiscal Responsibility Act of 1982 substantially tightened those limits, leaving hospitals with no upside — they could not earn a profit by reducing costs — and a growing downside for those whose costs exceeded the limits. The next year, legislation was passed, with the support of the hospital industry, replacing cost reimbursement with the inpatient prospective payment system (IPPS), with rates initially calibrated to leave Medicare outlays unchanged. Hospitals then had the opportunity to reduce costs per admission by shortening lengths of stay and to earn a positive margin in the process.

The IPPS is generally viewed as a major policy success: it encouraged hospitals to seek efficiencies, and when they found those efficiencies, it allowed the federal government to share in the savings. Should ACOs and other reforms prove effective, they will provide broader opportunities to increase the efficiency of delivery beyond shortening lengths of stay, such as managing chronic disease more effectively so as to keep beneficiaries out of the hospital in the first place. But our current challenge is more complex than the one faced in the early 1980s. Broadening the unit of payment will require reaching across different types of providers and helping to stitch together real delivery systems in places where now there are none.
 
The federal government (and state governments, too, since they're also working on this) is a payer, meaning the leverage it has to reform health care is payment policy. But the goal of changing payment policy is to prompt providers to redesign the delivery of care to make it better coordinated and more efficient and to deliver a better product. In other words, reward them for better care, make it financially feasible and desirable to offer better care more efficiently, and if necessary offer them some technical assistance to help them figure out how to make those changes. Then watch as they redesign what they do to produce better results more cheaply. This is what the Cleveland Clinic is doing. Yes, it's in response to payment policy, which is the reason those policies were instituted in the first place. To change behavior and produce better care.

The ACA has launched a number of payment reform experiments for providers who want to try them out and they're showing promise:

Obamacare-like groups may produce 'spillover' savings


Obamacare Shows Hospital Savings as Patients Make Gains


Obamacare pilot project lowers Medicare costs


But at a larger level, the law calls for reimbursement increases to providers across the Medicare program (except physicians under the Part B fee schedule) to slow over this decade. The idea is that this provides the impetus (in Cosgrove's own words!), along with the help provided by new payment model opportunities and other assistance in the law, to reform the delivery of health care to make it better and less costly. And if the Cleveland Clinic is any indication, it's already starting to work.

Anyway, this NEJM perspective from March 2012 lays out the rationale for cuts to spur progress: Slower Growth in Medicare Spending — Is This the New Normal?

If by working you mean massive layoffs will occur and more people will then queue up for fewer care providers, that must do ever more government paperwork, then it is working. Obviously if your clinic now has a staff of 40, but can afford only a staff of 30, under the new payment system, then they must drop 10 employees. The question is: did those 10 employees really do nothing of value and can the remaining 30 actually provide as much care (at the same quality) without them?
 
If by working you mean massive layoffs will occur and more people will then queue up for fewer care providers, that must do ever more government paperwork, then it is working. Obviously if your clinic now has a staff of 40, but can afford only a staff of 30, under the new payment system, then they must drop 10 employees. The question is: did those 10 employees really do nothing of value and can the remaining 30 actually provide as much care without them?

By "working," I mean improving the quality of care delivered while slowing rising costs. The idea that this requires providing "as much care" (i.e. service volume) as is delivered now, under a payment system that explicitly rewards higher service volume instead of high-value service delivery, is a misconception that's helped fuel huge cost growth in that industry for four decades.

We're not getting value for our health care dollar--this is pretty widely understand at this point, and it's why we pay $3 trillion to get the results and the system we do (an inefficient, fragmented, duplicative system with serious room for improvement in outcomes achieved).

We either want to cut costs relative to trend or we don't. If you think every dollar pumped into the health care system is spent well and wisely and is absolutely necessary for protecting patient health, then what's happening now probably alarms you (despite the fact that there's a huge push for measuring and rewarding quality to make sure savings are not achieved at the expense of quality). I don't believe that, which is why I believe things have to change. And they are changing now.
 

Tantrum by the Clinic? The ACA is supposed to save health care costs in the long run. So...it looks like it's working? No more raking in the profits for unnecessary services? The Clinic didn't say WHAT about the ACA is the cause of its panic. In fact, I've read where several companies have attributed upcoming cost measures to teh ACA generally, but they never say specifically which provisions are going to increase their costs.

When there is reform, there SHOULD be a shakeup in the health care industry, shouldn't there? It's tough to go through, but in any reform, that is inevitable. Otherwise, it's not really reform.

I hate to see it. I also hate to see people without enough money to buy food because of the cuts in food stamp programs. I also hate to see people suffer because they don't have the money to get treatment for their diabetes, high blood pressure, arthritis, or whatever. I also hate to see people unable to get health care because they can't get insurance for a pre-existing condition, like heart trouble.

Some people's situations will improve while going through the final stages of the reform, and others' situations will get worse.

We'll know more by the end of 2014 how things shake out. There will be changes in the bill in the future (there always are).

Problem is...it's easy to criticize and moan and groan. But this reform plan was better than the Republican one. Oh, wait...the Republicans didn't have a plan for the health care crisis in the country. ("What crisis?" was their view.)
 
The clinic is going to be more efficient, and cut costs, and the right wingers think this is A Bad Thing! :lamo
 
Dear private-practice citizens,


This is your Lord 0bama. From now on, you are no longer "private practice." I do not care one iota how much you have in student loan debt. I do not care one iota about your aspirations to become a successful person. I do not care one iota about any of your freedoms of running your clinic/office the best way you see fit. Basically, when it comes to this "we the people" bit...you're not included.

From now on, WE will dictate what you do. WE will dictate the price of your services, whether you agree with them or not. WE will dictate what your diagnoses will be. WE will dictate whether you're successful or not (get "really" successful out of your head right now, because we will not allow you to get too successful). WE will dictate your costs. WE will dictate what you pay your office help. WE will dictate a cap on your salary.

...and WE will extort much more taxation out of you, based on the salary WE dictate.


But, by all means...continue to consider yourself a "private practice" citizen. We don't want anyone to think we're fascist* now, do we?



Kisses,
The Imperial Government.



fas·cism (fshzm)
n.
1.A system of government marked by centralization of authority under a dictator, stringent socioeconomic controls, suppression of the opposition through terror and censorship, and typically a policy of belligerent nationalism and racism.
2. A political philosophy or movement based on or advocating such a system of government.
3. Oppressive, dictatorial control.
 
The ACA was passed in 2009 and took effect in 2010, with more and more provisions added every year. Next year is the last year for the final provisions.

Health care costs have started to stop rising as much. Refunds have been given for premiums paid (the refund notices come with specific cites to the provision of the ACA under which they are refunding part of a premium). There are allegations of increases in premiums because of the ACA, but I have yet to see even one which cites the provisions of the ACA that are the cause of the increases. It seems those are fake allegations. That's like saying, "I'm cutting your pay because of the federal government." Huh? What specifically has the federal govt done to cause you to cut my pay...is what people would ask.
 
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