The South Florida Sun Sentinel reports today (May 17th) that some south Florida Ob-gyns are refusing to see obese patients. The reported reasons are 1) exam tables and other equipment are not adequate and 2) the obese patients are riskier patients.
While it is not unusual for Ob-gyns to refer women to medical center specialists when they may have troubled pregnancies or deliveries, this seems a bit preemptive, although not technically discriminatory.
Limiting care for obese patients is not unknown, for example, some orthopaedic surgeons will not do knee replacements on morbidly obese patients due to a higher probability of surgical complications and a higher probability of joint failure. Obese patients may fail the protocols for elective surgery or safe anesthesia.
Obesity as a medical problem and as a medical treatment issue keeps....must I say it, .....growing. Rapidly. With difficult consequences. More to follow.
Tuesday, May 17, 2011
Accountable Care "Smackdown" Part III
The Feds fight back:
published in modernhealthcare.com, Berwick interview
http://www.modernhealthcare.com/article/20110517/NEWS/305179959?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmJVZndHRWxiNUtpQzMyWmV1NW5zWUpibW8=
published in modernhealthcare.com, Berwick interview
http://www.modernhealthcare.com/article/20110517/NEWS/305179959?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmJVZndHRWxiNUtpQzMyWmV1NW5zWUpibW8=
Accountable Care "Smackdown" Part II
While the feds were developing regulations for Medicare ACOs, both the feds and the American Hospital Association were developing cost numbers for ACO start-ups.
Today the AHA published its preliminary numbers, listing 23 major competencies to form and operate a hospital-based ACO (the AHA has been generally supportive of reform efforts, seeing a grim future).
The AHA costs estimates ranged from 600% and 1400% higher than the DHHS-CMS estimates. Both estimates are preliminary, but that is a huge difference. In my opinion (without deep analysis) the federal estimates have the substance of cotton candy.
On the list of 23 competencies, some were for formation only but most for formation and operations (my own list was 13 major competencies for on-going operations). The ACO is a very complex business model.
If ACOs do not fly, the major objectives of PPACA (Obamacare) will be difficult if not impossible to achieve.
Today the AHA published its preliminary numbers, listing 23 major competencies to form and operate a hospital-based ACO (the AHA has been generally supportive of reform efforts, seeing a grim future).
The AHA costs estimates ranged from 600% and 1400% higher than the DHHS-CMS estimates. Both estimates are preliminary, but that is a huge difference. In my opinion (without deep analysis) the federal estimates have the substance of cotton candy.
On the list of 23 competencies, some were for formation only but most for formation and operations (my own list was 13 major competencies for on-going operations). The ACO is a very complex business model.
If ACOs do not fly, the major objectives of PPACA (Obamacare) will be difficult if not impossible to achieve.
Friday, May 13, 2011
Accountable Care "Smackdown"
The American Medical Group Association represents about 400 very large and sophisticated multi-specialty physicians groups, such as the Cleveland Clinic group and Intermountain (Utah) group.
The Obama administration had counted on these groups to be the first to create Accountable Care Organizations (ACOs), starting with Medicare ACOs in 2012 and then moving to full service ACOs. These groups were more likely to have the resources necessary to start an ACO.
On Wednesday the group announced probably 90% of its members would not participate, because the draft regulations issued March 31st were too prescriptive, too operationally complex, the move to risk sharing is too quick, the gatekeeper and risk management capabilities requirements too much, and the time lines too short. The AMGA consensus is the chance of success is close to zero, so why waste resources.
If the big 400 cannot chew through this and come up with a workable plan, neither will other physician groups. Based on our recent conference attendance many provider organizations are taking the slow down approach.
It appears today only very large very integrated systems owning all of the necessary providers will be in the first wave. This could change for the better, but we doubt it. This could change for the worse though.
Not enough ACOs, no significant cost savings with quality improvement, no deficit improvement, train wreck.
The Obama administration had counted on these groups to be the first to create Accountable Care Organizations (ACOs), starting with Medicare ACOs in 2012 and then moving to full service ACOs. These groups were more likely to have the resources necessary to start an ACO.
On Wednesday the group announced probably 90% of its members would not participate, because the draft regulations issued March 31st were too prescriptive, too operationally complex, the move to risk sharing is too quick, the gatekeeper and risk management capabilities requirements too much, and the time lines too short. The AMGA consensus is the chance of success is close to zero, so why waste resources.
If the big 400 cannot chew through this and come up with a workable plan, neither will other physician groups. Based on our recent conference attendance many provider organizations are taking the slow down approach.
It appears today only very large very integrated systems owning all of the necessary providers will be in the first wave. This could change for the better, but we doubt it. This could change for the worse though.
Not enough ACOs, no significant cost savings with quality improvement, no deficit improvement, train wreck.
Sunday, May 1, 2011
Accountable Care Organizations
On March 31st the Obama administration issued the draft regulations for Medicare Accountable Care Organizations (ACOs).
ACOs are to eventually be the centerpiece of cost savings for the entire US health care system. This is the first peak at how the ACOs might be defined.
In the "they never learn" category, the draft regulations are 429 pages long.
http://www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdf
Some thoughts on the draft regulations:
1. The sections delineating what an ACO should accomplish and how to do it are well formed and should be adoptable without much change. Whether these ambitious goals are attainable is a major question and concern.
2. The feds are not certain who should participate in the first round of Medicare ACOs and have laid out many options that will require a great deal of comment and time to sort out. I suspect the more limited options (physician and physician-extender providers and hospitals) will be used for the first round.
It is likely the final regs will not be published until fall, and these ACOs are supposed to be operating January 1, 2012. This is a tight timeline.
ACOs are to eventually be the centerpiece of cost savings for the entire US health care system. This is the first peak at how the ACOs might be defined.
In the "they never learn" category, the draft regulations are 429 pages long.
http://www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdf
Some thoughts on the draft regulations:
1. The sections delineating what an ACO should accomplish and how to do it are well formed and should be adoptable without much change. Whether these ambitious goals are attainable is a major question and concern.
2. The feds are not certain who should participate in the first round of Medicare ACOs and have laid out many options that will require a great deal of comment and time to sort out. I suspect the more limited options (physician and physician-extender providers and hospitals) will be used for the first round.
It is likely the final regs will not be published until fall, and these ACOs are supposed to be operating January 1, 2012. This is a tight timeline.
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