What Boston’s Pioneer ACOs Will Mean For Patients

As we reported last week, five Boston area hospitals and physician groups will have a dominant role in a federal experiment that could transform Medicare. All Medicare patients who see doctors through Atrius Health, Partners HealthCare, Beth Israel Deaconess Medical Center, Mount Auburn Hospital or any of the Steward Health hospitals will be affected.  The question is how?

The Centers for Medicare and Medicaid Services (CMS) today announced 32 organizations that will “Pioneer” the move to accountable care organizations (ACOs). Greater Boston, with five of the 32, will have a large concentration of doctors and patients testing ways to coordinate care and reduce costs.

Medicare rules become the standard for payments and care at most hospitals.  So when these major groups in Boston start doing more preventive care or requiring more interaction among all a Medicare patient’s doctors, the same practices will likely apply — eventually — to patients of all ages.

This pilot will not restrict where patients go for care. Hospitals and doctors will be rewarded for beating their prior spending thresholds and for showing patient care improvements. These groups could lose money if patients need more care than they have in the past or if they get a lot of expensive care that isn’t coordinated.

CMS says this experiment could save $1.1 billion over the next five years.  That’s a lot of money, but keep in mind that the Medicare budget this year is $468 billion.

We asked leaders of each Boston area organization to answer this question: How will joining this pilot project affect the way you care for Medicare patients? Continue reading

Getting A Grasp On Global Payments: Prix Fixe Vs. ‘I’ll Have The Lobster’

As the Patrick administration pushes Massachusetts forward toward the cost-cutting phase of health reform, one of its guiding concepts is to shift the state from “fee for service” to “global payments.” That is, instead of being paid for each bit of care they give, health care providers will be put on an overarching “global” budget for each patient.

But how do we know that global payments work? And do they really save money? WBUR’s Martha Bebinger asks those important questions today in her report here, and takes a look at the early experience of some local global-payment hotspots: Commonwealth Care Alliance, Harvard Vanguard and Blue Cross Blue Shield. Already, she reports:

There’s a lot going on behind the scenes. Physicians are joining large practices so they’ll have help managing budgets. Clinics, rehab centers and hospitals are forming new alliances that put all our care under one umbrella group. And health insurers are negotiating contracts that send nurses to patients’ homes to avoid a hospital stay, but hold providers financially responsible if they don’t stick to a budget. In theory, these connections are supposed to lead to better care and lower costs.

“That makes a lot of sense in theory, but in practice, what does it mean?” asks MIT economics professor Jon Gruber. “What is the global budget?

“Who sets the global budget and for which payers? How much uprooting do you want to do, based on the limited evidence we have, that this will solve our theoretical problems?” Gruber continues. “I think it’s great we’re having this conversation. I just think it’s premature to say it’s a solution.”

Yet another early adopter of global payments, Lowell General Physicians Hospital Organization, is featured in a piece by Pippin Ross in the latest issue of the magazine CommonWealth, here.

Read both pieces and you come away with the impression that there are some positive initial experiences, but the jury is still very much out on whether global payments are a major solution for ever-rising health costs. And then, as Paul Levy hammers home on his Not Running A Hospital blog here, there’s the transparency problem: It’s awfully hard to tell how well even initial global payment experiments are working when so many of the financial figures involved are not publicly available.

Well, at least I picked up a couple of wonderful new analogies: In Pippin’s piece, Dana Safran of Blue Cross says that the current fee-for-service system creates a mentality of “If you’re paying, I’ll have the lobster.” In contrast, the story’s headline describes a global payment system as “prix fixe.”

Top 10 Snippets In New Snapshot Of State’s Health Care Reform

“I live here. I already know all this. I feel it in my own medical care and insurance bills.”

That was my first reaction when I saw that the Center for Studying Health Systems Change had just put out a new report on how health care reform has affected Massachusetts, funded by the Robert Wood Johnson Foundation.

I was wrong. I found a motherlode of interesting nuggets in the overview, some little reported before, others the kinds of things that everybody knows but nobody much says. They come from a team of health care researchers who visited the Boston area in March and spoke with more than 50 health care leaders across the board, from doctors to benefits consultants to state officials, then followed up through the summer. Sometimes, I’m thinking, people say things when they’re speaking anonymously to a researcher that they might never say in public…Herewith some excerpts:

1.Doctors who own imaging centers are trying to sell them to hospitals, which can charge more Continue reading