Video: Supreme Court case could be death spiral for the Affordable Care Act.
It looks at:
Rising spending.
Quality improvement.
Program fragmentation.
Coverage gaps.
Proposals to improve Medicare, including provider-payment reform (especially moving to fee for quality and value from fee for service) and organizational reform.
The article notes:
”Despite its intuitive appeal, value-based purchasing faces a number of challenges. It depends on the development of effective, and preferably outcome-based, measures. …{C}ritics point out that value-based purchasing should more effectively utilize the power of nonfinancial incentives, such as professionalism and organizational culture, in motivating clinician behavior and improving performance.”
A strike by physicians at University of California Student Health has raised big issues. A key demand by the doctors, who provide primary-care and mental-health services, was to obtain more financial information from the system to use in negotiations. Finances of health institutions remain famously opaque, as does the matter of what really is meant by “nonprofit” when applied to institutions with very high executive salaries.
The doctors joined the Union of American Physicians and Dentists in November 2013.
They were also upset by demands that they pay more into their pensions, and they feel that the system is making them rush through their patients to increase volume.
As more and more doctors give up private practices and become institutional employees, we can probably expect more strikes.
And U.S. physicians, as the most highly paid in the world, might use union membership to fight efforts to substantially reduce their pay and other perks, though such reductions seems inevitable given government and other payers’ pressures to control our healthcare system’s costs in the face of the “Silver Tsunami” and other pressures.
“Precision Medicine” seeks to use an individual’s genetic data, environment, and lifestyle characteristics to customize healthcare treatments and prevention strategies.
The bulk of the $215 million would go to the National Institutes of Health and the National Cancer Institute, with the Food and Drug Administration and the Office of the National Coordinator for Health Information Technology (ONC) receiving smaller amounts.
“Participants will be involved in the design of the initiative and will have the opportunity to contribute diverse sources of data — including medical records; profiles of the patient’s genes, metabolites (chemical makeup), and microorganisms in and on the body; environmental and lifestyle data; patient-generated information; and personal device and sensor data,” said the White House.
We at Cambridge Management Group would like to know more about how the president’s plan would affect research, and use of that research at hospitals, especially at teaching hospitals affiliated with medical schools engaged in intensive research. Hospital oncology departments would, presumably, be particularly big beneficiaries of the program.
Francis Collins, M.D., who runs the National Institutes of Health, has said the cancer part of the program is “much closer to clinical benefit” than many know.
”The roles and responsibilities of the two positions made working together difficult in the past,” John Byrnes, M.D., a board member of the Healthcare Financial Management Association and founder of the Byrnes Medical Group, told the news service.
“CMOs generally don’t have a business background, so they speak a different language than the CFO and vice-versa,” noted Dr. Byrnes, the former CMO of SCL Health, in Denver.
The disconnect includes building design. “You don’t really find finance offices close to clinical care, patient care areas,” he said.
But with the Affordable Care Act, Dr. Byrnes says, “CFOs are starting to realize that any improvement in care that the chief medical officer can drive through the organization also has significant financial benefits because more often than not it will remove some of the unnecessary costs in patient care out of the organization.”
Finding common ground benefits both the clinical and the financial sectors because it bridges the goals of lower costs and improved patient outcomes.
”Vanitas,” by Philippe de Champaigne, showing three essentials: Life, Death, and Time
This James Carroll column discusses Atul Gawande, M.D., author of Being Mortal, the daily troubles of life and the biggest thing of all — knowing that we will die.
The questions discussed:
“What are the most appropriate alternative payment models?”
“How much impact on quality and cost of care do you expect to see?”
“What unintended consequences do you worry about?”
Among the more interesting remarks were those of Richard Kravitz, M.D., who said:
”{R}egardless of the accounting scheme, value-based payment requires systems for measuring both medical risk and quality reproducibly and accurately. Our ability to measure quality at the aggregate level is excellent, but quality assessment at the individual level lags far behind.”
Harvard Medical School.
This HealthAffairs blog notes:
This has to change, the authors say, and note:
”Across … undergraduate and graduate education, including schools of public health, business, nursing, health administration, and medicine, there are significant opportunities to add innovation components to all of these {healthcare-related} curricula and to include innovation as a crucial component of lifelong learning requirements.”