Just Wind The Clock- It's Going To Happen Again

Last Friday the leadership in Congress and the Executive branch finally came to a last-minute agreement to narrowly avert a government shutdown. As expected, everyone waited until the last minute before finally showing their hand.

A soldier in Afghanistan (supporting a family back home) wondered if he was going to be paid. Some of these heroes literally live paycheck-to-paycheck. So, while dodging Taliban snipers and trying to avoid IEDs planted in the road, he now had to worry if his wife and children would have the money they needed for support while he was gone.

It's inexcusable- unfortunately this is the world of politics, partisanship, and debt we live in today.

Congress will likely pass the $38 billion in "reductions" that were part of the final agreement to create the FY2011 budget (many months late). Just to add to the confusion surrounding what was actually accomplished, the CBO posted their analysis of the deal the day before the vote stating the number isn't really $38 billion but somewhere around $350 million for FY2011 due to the maze of IOUs, transfer accounts, and other accounting gimmicks included in our federal accounting process. To add more fuel, they posted their projections indicating our deficit for the first six months of the year will be about $800 billion- over $110 billion more than the same time last year. We aren't making much progress.

The politics are getting uglier- and Americans have no idea who to believe.

While the lights remain turned on for now, these last-minute agreements are unfortunately going to be the norm. The fiasco that occurred last week is a drop in the bucket compared to what we're going to experience when the votes to raise the debt ceiling and the 2012 budget debates really get underway. Quite honestly, the stability of our economy is at stake.

Republicans want to use the scorched-earth approach, Democrats want to protect self-interests. Most of us know the right answer is somewhere in between. It's now a game of chicken- and we're all on the receiving end.

We'd better brace ourselves. The coming months are not going to be pretty. Whether we want to accept reality or not- addressing health care and entitlements (Medicare, Medicaid, and Social Security) will be or should be central to the discussion.

The world has changed and America has changed and now is the time we'll really see what we're made of. We had just better be sure we don't ask those who are already sacrificing so much while they are protecting our freedoms in hostile environments to sacrifice more just because we can't get our act together here at home.

We're better than that.

The New Proposed Rules for ACOs- Can We Make 429 Pages Understandable?

The Department of Health and Human Services just released the “proposed rules” for creating Accountable Care Organizations. Accountable Care Organizations (ACOs) were legitimized in the Affordable Care Act as a way to try to curb the unsustainable Medicare costs occurring today by organizing the way beneficiaries receive care in a different way. I believe the idea could be simplified by simply saying they change the way providers are paid by working together better than they do today. These proposed rules (requesting comment from the public) are 429 pages and will be a field day of billable hours for policy consultants, actuaries, financial analysts, and statisticians. With all of the data requirements included, technology companies and the IT departments at health care organizations are going to have some great opportunities (and a lot of work) if they play it right. You can grab the proposed rules by clicking HERE (it’s a big PDF file so hopefully your computer won’t choke).

Accountable Care Organizations are part of the Medicare Shared Savings program included in the ACA and are intended to create organizations to “expand value-based purchasing, broaden quality reporting, improve the level of performance and feedback to suppliers, create incentives to enhance quality, improve beneficiary outcomes, and increase the value of care." The idea is to reward providers for delivering high quality, efficient clinical care for Medicare beneficiaries. The rules themselves sound remarkably similar to the HMOs that everybody hated- but ACOs are supposed to be different. They are going to be primarily run by hospitals and provider groups instead of insurance companies, and supposedly will be less restrictive with the patients and allow for individuals to see providers outside the network if they want. We'll see.

I read that the health care industry tends to operate with “kind of a herd behavior, rushing to implement an idea without working through the detailed business questions of how they’ll work.” ACO’s are the new hot topic in health care and the herd is building. They sound like a good idea (and could be a survival strategy for some provider organizations and hospitals) so many folks are jumping on-board, they just don’t know how it’s all going to work.

HHS estimates 5 million Medicare beneficiaries will be enrolled in ACOs in the next few years. Somewhere between 75 and 150 ACOs are supposed to be operational over the next three years and will cost around $1.75 million each to get set up. The start-up costs are primarily going to be borne by the private market. HHS believes Medicare will save a little over $500 million over the next 3 years (median number). That’s a pretty small portion of overall Medicare spending- but it’s a start.

Once again, I wonder about the patients.

The rules spend quite a bit of time talking about the importance of being “patient centered” but nobody is talking about how to get the patients and individuals ready to be “patient centered.” What will happen when a patient wants to go outside the network impacting any bonus payment the ACO might receive? What will happen when the patient wants every possible test and procedure that the ACO may not believe is necessary? That’s going to determine the real success of ACOs. Can health care finally relate to people on an individual level?

As they are outlined today, the rules acknowledge that public and patient support is going to be required to make all of this work- but doesn’t quite define how. The rules state, “The exercise of free choice, however, can be undermined or even nullified if beneficiaries do not possess adequate information to assess the possible consequences of available choices, or to evaluate which available options are most consistent with their values and preferences concerning their own health care.”

Health care is going to need to connect with people in new ways. Brochures, pamphlets, and marketing materials are not going to cut it any more. Individuals need to be educated and informed about the basics of ACOs to be able to participate like ACOs are going to need them to participate.

Consumer education needs to be a priority and not just an exercise shoved off to the marketing department or handled like health care has handled communication and education in the past. Consumers are having a tough time trusting health care right now- 429 pages of rules may be a billable hour windfall for the consulting companies, but it doesn’t make things any easier for those who are really going to need to know what is expected and are going to be asked to participate in ways they haven’t had to in the past.

Let's hope we can start connecting.