Uncategorized Category

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.

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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.

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CMS’s ‘medical home’ experiment is a mess

In: Uncategorized

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.

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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.

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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.

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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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The health-cost slowdown isn’t just about the economy By David Leonhardt New York Times, December 5, 2014 It’s one of the most important economic questions today: Is the snail-like growth of health costs over the last several years a real trend, or is it merely a temporary part of the Great Recession’s aftermath? The data […]

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MedPAC continues to ignore ACO overhead

In: Uncategorized

In a comment I posted on this blog last December, I noted that the Medicare Payment Advisory Commission (MedPAC) refuses to ask a very obvious question about the two Medicare ACO programs authorized by the Affordable Care Act: Do the administrative costs of running an ACO exceed the savings ACOs allegedly achieve for Medicare?

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Big data: The latest fad in health policy

In: Uncategorized

In case you blinked, big data is the newest new thing in establishment health policy.

We need an analysis of errors in health policy and why those errors go uncorrected long after they have been revealed. I would like to suggest that the IOM undertake this task. I suggest they entitle their report, “To Err is Human, and Health Policy is No Exception.”

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