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Dartmouth discusses its ACO woes


Dartmouth-Hitchcock Medical Center.

Healthcare leaders at the Geisel School of Medicine at Dartmouth College and the affiliated Dartmouth-Hitchcock Medical Center have been busily explaining to the national news media their decision to scrap their Accountable Care Organization — a  model mostly invented at Dartmouth.

A New York Times story said that Dartmouth’s ACO cut Medicare costs on hospital stays, tests, imaging and other procedures. But although it met its goal for quality of care, the Feds still penalized Dartmouth’s ACO  for not reaching cost-savings benchmarks, which prompted it to exit the program last fall.

Robert A. Greene, M.D., an executive vice president in the Dartmouth-Hitchcock Health System, told  The New York Times that  that the cost-cutting, in combination with federal penalties, was not sustainable for the system. Elliot S. Fisher, M.D., director of Dartmouth Institute for Health Policy and Clinical Practice and one of the designers of the ACO model, noted the disappointment of himself and his colleagues.

“It’s hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with,” Dr. Fisher told The Times.

A Health Affairs blog post said that  the Centers for Medicare & Medicaid Services  data suggest that while more ACOs are finding success,  financial performance and health outcomes can vary widely across America. In late August, CMS reported that that fewer than a third of ACOs qualified for Medicare bonuses.

To read a FierceHealthcare report on ACO issues, please hit this link.

To read a Health Affairs post on ACO performance, please hit this link.

To read The New York Times’s story on this, please hit this link.

Dartmouth study: Overuse seems under-targeted


A Dartmouth study of healthcare utilization found “that more than 90 percent of 521 outpatient measures targeted underuse. A mere 7 percent of measures targeted overuse ─ that is, measured how often excessive care was being provided. In addition, nearly half of collections contained no overuse measures at all.”

Brenda Sirovich, M.D., of the Dartmouth Institute for Health Policy and Clinical Practice, and some colleagues looked at clinical-performance measures in the hopes of determining their potential large-scale impact on clinical care.

“It’s seemed to a lot of folks that these measures predominantly target underuse of care,”  Dr. Sirovich said.  “If it’s true that incentives tend to consistently reward providers for doing more, there’s a good chance it contributes ─ unintentionally ─ to the problem of overuse of healthcare services.”

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