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.
For nearly a half century now, the holy grail of the managed care movement has been the consolidation of the nation’s insurance companies, hospitals and clinics into large “Kaiser-like” entities.
MedPAC’s job is to advise Congress on how to improve Medicare. It can’t do that if it continues to promote the double standard: evidence-based medicine for doctors and faith-based health policy for MedPAC.
We can’t reform the delivery system without reforming the financing system.
This excerpt from the transcript of MedPAC’s January 2015 meeting indicates MedPAC continues to guess that ACO overhead is in the range of 1 to 2 percent of expenditures and that MedPAC continues to ignore those costs in calculating total spending on ACOs participating in Medicare’s ACO programs. Later portions of the transcript indicate ACOs are saving so little money, and are therefore getting such small “shared savings” payments back from Medicare, that ACOs are losing money. But MedPAC continues to ignore that fact as well.
In a previous post, I said the CPC Initiative would fail to produce usable results because it sought to test too many vaguely defined variables at once. In this comment I level the same criticism against the MAPCP demonstration.
The Comprehensive Primary Care Initiative, like all tests of the “medical home,” attempts to assess the impact of too many vaguely defined variables at once.
This report by Mathematica analyzes the first year of a four-year experiment being conducted in eight states by the Center for Medicare and Medicaid Innovation, an agency established within the Centers for Medicare and Medicaid Services (CMS) by the Affordable Care Act.
What’s true in medicine is true in health policy: If you don’t diagnose correctly, you can’t prescribe correctly. If you think the primary care sector needs “redesign,” you will prescribe “medical homes” and “breaking down silos” and other nostrums with labels connoting a change in structure. If, on the other hand, you conclude the proper diagnosis is too few resources, then you recommend more resources.
The “medical home” concept has become counterproductive. It is muddling the debate about how to improve medical care without raising costs, and it is punishing primary care clinics. The paper by Mosquera et al. illustrates both problems.
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