I am not a doctor. Nor was I trained in establishment health policy ideology by a graduate school of economics or health policy. I state that I am not a doctor not because I hold the condescending view of doctors held by CMS and those who enacted MACRA, but because I want to make it clear I cannot be accused of having the bias that CMS and other MACRA proponents allege that doctors have.
No poll has ever posed these questions: “Do you support or oppose a health insurance system in which everyone would be covered by a program like Medicare? Would your opinion change if you knew such a system would: Lower total spending on health care; restore patient choice of doctor; give doctors more control over medical decision-making?”
About half of Americans would prefer a single government health plan for everyone, according to this poll. However, when offered several choices, more would prefer to build on the current system (36%) than would prefer to establish a single government plan (24%). Also, followup questions show that the opinions of a single government plan are quite malleable, depending whether the query has a positive or negative slant.
Slavitt has put himself in a box. He has admitted that Obama’s and Congress’s decision to force doctors to use the clumsy electronic health records (EHRs) sold by the American computer industry was bad policy, but he has no idea how to fix that problem. All he can do is talk like Donald Trump – he’ll come up with “something better.”
The Medicare Payment Advisory Commission (MedPAC) has become so confused about the “patient-centered medical home” (PCMH) it will soon meet itself coming around the corner.
Research on “patient-centered medical homes” (PCMHs) consistently finds they have little or no effect on medical costs and mixed effects on quality. This paper by Rosenthal et al. confirms that research. The paper evaluated the Colorado Multi-Payer Patient-Centered Medical Home Pilot, one of the earliest tests of the PCMH concept administered by multiple insurers.
It doesn’t have to be this way. Lack of health insurance, unaffordable out-of-pocket costs, network restrictions, preauthorization requirements, penalties for readmissions, all stem from our private-insurance-based system.
In this comment I focus not on CMS’s costs, but the costs incurred by the FQHCs that “transformed” into “medical homes.” RAND reports that it is unable to determine what those costs are and what the “medical homes” do with the subsidies they receive from CMS.
One of the hottest new fads in managed care is “patient engagement,” aka “patient activation.” How hot? So hot Health Affairs devoted its February 2013 issue to the subject. But this fad is being sabotaged by a slightly older fad – pay-for-performance (P4P).
In July the RAND Corporation released a report on the second year of CMS’s three-year “medical home” experiment with federally qualified health centers (FQHCs). The report concluded the clinics in the “medical home” arm of the experiment were spending more money than clinics in the control arm, and that this was unlikely to change by the end of Year 3. Sad to say, we’re never going to know what it was the experimental clinics did that raised their costs
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