nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, March 31, 2011

Despite No Demonstrated Success We're Pressing Ahead With Accountable Care Organizations

The head of Medicare appears to say (IMO), "We're pushing ahead with Accountable Care Organizations (ACO) even if it costs more and doesn't improve quality."

Readers who looked closely at my posts on outcomes-oriented and performance-based approaches to health care have seen analyses and research studies that show they don't least the way they are being implemented.

ACO's are another term for these efforts.  They wrap a health care team around financial incentives to be more efficient and reduce cost by paying more when certain standards of quality are met.  In other words, doctor groups that don't improve care or reduce cost will make less.  It's all about incentives...i.e., money.

Unfortunately, as I wrote, the government's demo of this concept under Obamacare provided too little in bonuses to pay for the initial investment over the first three years, and was unlikely to get better into the coming years.  All this, despite the fact that the Demonstration Project under HCR cherry-picked big, successful doctor groups to show how ACO's could work.

Dr Berwick, the President's recess appointment to run Medicare/Medicaid (remember?  it was feared his controversial beliefs would undermine Senate confirmation of the appointment) published a commentary in this week's New England Journal of Medicine (NEJM, Mar 31) that basically says, "Don't sweat the fact that the companies lost money:"
"What can we reasonably expect of the coming wave of ACOs? We know that not all previous efforts at developing a model of shared savings have met expectations."
But we're pressing ahead because it's the best "right" thing that we haven't figured out how to make work or achieve it's stated goals.

In the commentary, Dr. Berwick's nod to the demonstration product as having only achieved "modest" savings is Political Speak.  It means, "Yes, it didn't work, but we think it still will, despite the fact that we picked the doctor practices that we thought would surely succeed and even they can't recoup their investment in the ACO process."  For us simple folk, the businesses lost money.

I've written about Dr. Berwick's organization (The Institute for Healthcare Improvement) and it's Patient-Centered Care concept before.  See here for a criticism of what that means to the patient's ability to choose the care they need and want.

Several months after writing about it, I still think that Americans don't want Patient-Centered Care.  They want Patient-Directed Care.

Doc D

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