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Mergers leading toward a ‘de facto single payer’?

In: Uncategorized

Q:  If large insurers continue to merge, does that create a “de facto single-payer” health system? A:  No. Several pundits have suggested that the recently announced plans of Aetna to merge with Humana, and of Anthem to merge with Cigna, signify the emergence of a de facto private-insurance-based single payer. Such speculation is unfounded for […]

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In this op-ed, Ezekiel Emanuel and his co-author admit health care inflation is heating up and accountable care organizations (ACOs) are failing to cut costs. Those are significant admissions coming from Emanuel, one of the planet’s most aggressive proponents of ACOs.

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Managed care proponents suffer from the free-lunch illusion – the illusion that the managed care interventions they support are free or, at worst, cost so little those costs can be totally ignored in reporting the alleged savings achieved by the intervention. This illusion is rarely questioned by reporters or editors of professional journals.

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Uncontrolled inflation of health care costs continues unimpeded as insurers, hospitals, drug companies, and others in the medical-industrial complex embrace expanded and subsidized new markets with minimal oversight. This problem is growing worse as insurers and hospitals consolidate, gain near-monopoly market shares, and raise their prices to what the traffic will bear. Meanwhile, the bureaucracy and cost of the ACA’s infrastructure continues to grow.

The annual “churn” rate among Medicare accountable care organization (ACO) doctors and assigned patients is enormous: It averages around one-third for both doctors and patients. Because of this constant doctor and patient turnover, ACOs lose the majority of their assigned patients over a five-year period. How is an ACO supposed to be held “accountable” for services given to such a rapidly changing panel of patients by such a rapidly changing roster of physicians?

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CMS’s latest ACO report is inscrutable

In: Uncategorized

Stuart Guterman’s characterization of CMS’s latest report on the Pioneer ACO program is accurate. It is impossible to explain the report’s findings.

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The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) are violating a fundamental rule of science: They are soft-pedaling the disappointing financial results of the Pioneer ACO program and trumpeting the results of a simulation of the program.

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Physician burnout is finally drawing the attention of the mainstream media. But the media is failing to connect the problem to the takeover of medicine by large corporations and the usurpation of physician and patient decision-making authority by the managers of those corporations.

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If research continues to confirm that managed care cannot save money when it is applied indiscriminately across an entire population, and can only do so when it is applied to a tiny fraction of patients, that will not bode well for managed care.

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The MIPS composite score will be a meaningless number for three reasons: The attribution method will be grossly inaccurate, the risk-adjustment method will be grossly inaccurate, and the useless cost and quality scores these methods will produce will be mashed together by an arbitrary 70-30 weighting ratio.

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Physicians for a National Health Program's blog serves to facilitate communication among physicians and the public. The views presented on this blog are those of the individual authors and do not necessarily represent the views of PNHP.

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