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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsA little known, but potentially fantastic provision of the Affordable Care Act
A little known, but potentially fantastic provision of the Affordable Care Act
by THirt
<...>
As you can see, the fee-for-service environment does not really incentivize physicians to focus their efforts on chronic disease management. I'm not implying that physicians are not trying to do a good job or are just in it to make as much money as possible, but let's face it: if you make the same amount per patient, and you can see 30 patients with ear infections or 15 diabetic/hypertensive/hyperlipidemic patients, which would you choose? How would you set up your schedule?
Everyone agrees that prevention is the most cost-effective way to keep people healthy. Vaccines, for example, are arguably the single most cost-effective thing in all of medicine (get your flu vaccine if you have not already done so, by the way!). Preventative care is now covered without a co-pay because of the ACA. That is awesome. However, better care/control of chronic disease doesn't pay well, as discussed above. But better control of diabetes, of BP, of cholesterol, of COPD, of asthma, of heart failure will save lots and lots and lots of money in the long run because complications of all these diseases are expensive. It costs a LOT to be in the hospital, to have a heart bypass, to have dialysis, etc. A rough estimate is that a well-controlled diabetic costs the system an average of $4,000 per year to take care of, but an uncontrolled diabetic will cost $16,000 or more. So why would we pay doctors the same for an ear infection as we would to take care of serious chronic disease?
Part of the answer unfortunately is that people switch insurances and by the time they develop more significant complications, they are on Medicare anyway, so UHC, Humana, Anthem don't need to worry about paying for dialysis. In the long run, though, it saves us all money if we do a better job of taking care of chronic illness. So it makes sense to try to incentivize doctors to improve our chronic disease management instead of incentivizing doctors to just see as many patients as possible in the day.
So enough background. Here's the good stuff. The ACA provides funding and guidance for a new way to approach health care. The Comprehensive Primary Care initiative is a program that involves about 500 practices across the country, in several geographic areas. Southwest Ohio/N. KY, New Jersey, Arkansas, Colorado, New York, Oregon, and Oklahoma have participating practices. Practices were selected based on a number of factors, including past willingness to participate in such things as NCQA quality recognition, and patient-centered medical home (PCMH) certification. You can read more here: http://innovation.cms.gov/...
Basically, CMS (center for Medicare and Medicaid services) provides funding outside of the fee-for-service environment for practices to do a better job of chronic disease management. There is/was a detailed application process, and multiple milestones you have to meet, but a lot of it boils down to CMS providing additional monies for practices to use as they see fit in order to help improve the care for their patients, particularly (although not exclusively) those with higher risk chronic illness.
The whole thing is actually really interesting. While there are quite a lot of specifics, there are also a lot of areas open to interpretation. CMS is partnering with multiple private insurance carriers to provide a monthly fee (outside of any appointment or fee-for-service interaction) to physician practices in order to help those practices invest in infrastructure which will help improve patient care. The amount per patient per month is based on risk assessment. Basically, the more diagnoses, and the more complicated a patient is, the higher the monthly fee. A well-controlled diabetic would have a lower fee than a diabetic with chronic kidney disease, heart disease, and neuropathy. So right off the bat, you can see how this is a paradigm shift from the traditional fee-for-service environment. You may actually be paid more to take care of a more complicated person and try to keep them out of the hospital.
However, and this is a BIG part, the money from this CPC initiative can NOT be paid to physicians as compensation. It is to be used to improve infrastructure. This is actually pretty cool because instead of just paying doctors more and saying, "hey, if we pay you more, you'll do a better job, right?", CMS is saying, "we will give you money to use as you see fit (within the structure of our program and its milestones) to improve patient care which should improve outcomes, decrease severe complication rates, improve patient satisfaction, and eventually decrease overall costs through an investment up front."
- more -
http://www.dailykos.com/story/2013/10/27/1250950/-A-little-known-but-potentially-fantastic-provision-of-the-Affordable-Care-Act
by THirt
<...>
As you can see, the fee-for-service environment does not really incentivize physicians to focus their efforts on chronic disease management. I'm not implying that physicians are not trying to do a good job or are just in it to make as much money as possible, but let's face it: if you make the same amount per patient, and you can see 30 patients with ear infections or 15 diabetic/hypertensive/hyperlipidemic patients, which would you choose? How would you set up your schedule?
Everyone agrees that prevention is the most cost-effective way to keep people healthy. Vaccines, for example, are arguably the single most cost-effective thing in all of medicine (get your flu vaccine if you have not already done so, by the way!). Preventative care is now covered without a co-pay because of the ACA. That is awesome. However, better care/control of chronic disease doesn't pay well, as discussed above. But better control of diabetes, of BP, of cholesterol, of COPD, of asthma, of heart failure will save lots and lots and lots of money in the long run because complications of all these diseases are expensive. It costs a LOT to be in the hospital, to have a heart bypass, to have dialysis, etc. A rough estimate is that a well-controlled diabetic costs the system an average of $4,000 per year to take care of, but an uncontrolled diabetic will cost $16,000 or more. So why would we pay doctors the same for an ear infection as we would to take care of serious chronic disease?
Part of the answer unfortunately is that people switch insurances and by the time they develop more significant complications, they are on Medicare anyway, so UHC, Humana, Anthem don't need to worry about paying for dialysis. In the long run, though, it saves us all money if we do a better job of taking care of chronic illness. So it makes sense to try to incentivize doctors to improve our chronic disease management instead of incentivizing doctors to just see as many patients as possible in the day.
So enough background. Here's the good stuff. The ACA provides funding and guidance for a new way to approach health care. The Comprehensive Primary Care initiative is a program that involves about 500 practices across the country, in several geographic areas. Southwest Ohio/N. KY, New Jersey, Arkansas, Colorado, New York, Oregon, and Oklahoma have participating practices. Practices were selected based on a number of factors, including past willingness to participate in such things as NCQA quality recognition, and patient-centered medical home (PCMH) certification. You can read more here: http://innovation.cms.gov/...
Basically, CMS (center for Medicare and Medicaid services) provides funding outside of the fee-for-service environment for practices to do a better job of chronic disease management. There is/was a detailed application process, and multiple milestones you have to meet, but a lot of it boils down to CMS providing additional monies for practices to use as they see fit in order to help improve the care for their patients, particularly (although not exclusively) those with higher risk chronic illness.
The whole thing is actually really interesting. While there are quite a lot of specifics, there are also a lot of areas open to interpretation. CMS is partnering with multiple private insurance carriers to provide a monthly fee (outside of any appointment or fee-for-service interaction) to physician practices in order to help those practices invest in infrastructure which will help improve patient care. The amount per patient per month is based on risk assessment. Basically, the more diagnoses, and the more complicated a patient is, the higher the monthly fee. A well-controlled diabetic would have a lower fee than a diabetic with chronic kidney disease, heart disease, and neuropathy. So right off the bat, you can see how this is a paradigm shift from the traditional fee-for-service environment. You may actually be paid more to take care of a more complicated person and try to keep them out of the hospital.
However, and this is a BIG part, the money from this CPC initiative can NOT be paid to physicians as compensation. It is to be used to improve infrastructure. This is actually pretty cool because instead of just paying doctors more and saying, "hey, if we pay you more, you'll do a better job, right?", CMS is saying, "we will give you money to use as you see fit (within the structure of our program and its milestones) to improve patient care which should improve outcomes, decrease severe complication rates, improve patient satisfaction, and eventually decrease overall costs through an investment up front."
- more -
http://www.dailykos.com/story/2013/10/27/1250950/-A-little-known-but-potentially-fantastic-provision-of-the-Affordable-Care-Act
Interesting stuff.
Comprehensive Primary Care Initiative
http://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/
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A little known, but potentially fantastic provision of the Affordable Care Act (Original Post)
ProSense
Oct 2013
OP
Good point. There are a number of similar new approaches incentivized by the ACA to produce better
Hoyt
Oct 2013
#1
lol, funny I was making the same point the other day with the soon to be gone dfk
grantcart
Oct 2013
#7
It's a shame how little is known about Obamacare. I wish the Administration had a budget for
okaawhatever
Oct 2013
#8
Hoyt
(54,770 posts)1. Good point. There are a number of similar new approaches incentivized by the ACA to produce better
outcomes and control costs.
ProSense
(116,464 posts)6. Yup, very interesting. n/t
sheshe2
(83,751 posts)2. I like it!
It makes a good incentive,
You may actually be paid more to take care of a more complicated person and try to keep them out of the hospital.
Hutzpa
(11,461 posts)3. Thanks for posting this
good to know some of the benefits of ACA.
Response to ProSense (Original post)
Post removed
ProSense
(116,464 posts)5. You're posting stuff from this site
Age of Autism (often abbreviated to AoA) is a site that hosts the blogs of the leaders in the field of anti-vaccination crankery. Their bloggers include the likes of Mark Blaxill, David Kirby, J.B. Handley, and, of course, Jenny McCarthy. They also peddle "treatments" for autism produced by alternative medicine woo-meister Lee Silsby, which consist of vitamin supplements and other nature woo.
http://rationalwiki.org/wiki/Age_of_Autism
http://rationalwiki.org/wiki/Age_of_Autism
grantcart
(53,061 posts)7. lol, funny I was making the same point the other day with the soon to be gone dfk
okaawhatever
(9,461 posts)8. It's a shame how little is known about Obamacare. I wish the Administration had a budget for
information and rolling it out. I wonder how many people won't even know about preventive care? Thanks for the heads up.
ProSense
(116,464 posts)11. The law survived the barrage of misinformation and Republicans blocking additional funding.
With it gaining popularity they have an opportunity now to do some serious promotion.
Hope that happens.
Scurrilous
(38,687 posts)9. Thanks ProSense.
K & R
IrishAyes
(6,151 posts)10. Verrrry interesting indeed.
I'm a big fan of preventive care. And it starts at home with good nutrition, the best medicine of all.
Now for more wishes; I'd love to see ACA covering more Oriental medical disciplines.
BluegrassStateBlues
(881 posts)12. K&R for a fine piece of progressive legislation. nt