Cooperating for better care.

Geisel School of Medicine

Tag Archives

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.

Gilbert Welch touts the simplicity of single payer


“Our current system of multiple payers is supposed to foster competition, which in turn is supposed to make health care more affordable, more accessible and have higher quality,” writes Dartmouth’s H. Gilbert Welch, M.D., in a CNN opinion piece. “How could a single payer ever improve on that?”

Easily, writes Welch, a professor of medicine at the Geisel School of Medicine and atThe Dartmouth Institute for Health Policy & Clinical Practice.

“First, multiple payers multiply the complexity for patients,” he wrote for CNN. “Sure there are many choices, but patients may not understand the tradeoffs involved—often because they have incomplete information (Exactly who is in-network anyway?). While there may be some who enjoy all these choices, they are overwhelming for many.

“And for those who might be eligible for financial assistance, there is another set of hurdles in simply determining their eligibility (What will your income be?). These hassle factors loom particularly large for those who have little immediate motivation to care about insurance—the young—the very group we’d most like to have it.

“With a single payer these complexities disappear: Everybody is in, nobody is out.”

Contact Info

(617) 230-4965

Wellesley, Mass