Understanding the True Costs of ACOs and Medical Homes

By KIP SULLIVAN One of the privileges of being a managed care advocate is that you never have to discuss the unpleasant question of how much your proposed intervention will cost. Whether your proposed intervention is HMOs, report cards, pay-for-performance, ACOs, “medical homes,” or electronic medical records, you never have to estimate what your bright idea will cost. With this privilege comes another: You are free to criticize doctors and hospitals for being “cost unconscious.” Over the last decade, CMS has become a proponent of this double standard – cost consciousness for doctors and hospitals and cost unconsciousness for the health policy illuminati . Beginning with the Physician Group Practice Demonstration, which ran from 2005 to 2010, and running through today’s ACO and “medical home” demos, CMS has assiduously avoided reporting the costs that clinics and hospitals incur to participate in these demos. Jeff Goldsmith and Nathan Kaufman  have described CMS’s behavior as “sunny obliviousness to provider economics.” [1] Cost unconsciousness permeates CMS’s MACRA rule CMS’s cost unconsciousness is on vivid display in its proposed MACRA rule . About two-thirds of the way into the rule, CMS admits: it does not know what it costs doctors to implement electronic medical records nor whether the benefits of EMRs exceed the costs (p. 669); it does not know what it costs doctors to participate in “medical homes” (p. 670); it will allow ACOs and “...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs