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2 posts from April 2018

04/18/2018

Kip Sullivan Discusses the Flaws and Future of the Medicare ACO Program (April 17th)

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The Medicare Shared Savings Program's Accountable Care Organization (ACOs), created by Section 3022 of the 2010 Affordable Care Act constitutes the flagship Medicare pay for performance (P4P) program.  Though there are other P4P (also termed pay for value) models, for example two bundled payment models (Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement), they are short-lived CMS demonstrations.   If the federal government is to bend the Medicare spending curve or make the program more financially sustainable it will likely be due moreover to the success of ACOs.  Though provider participation in ACOs is substantial, this year there are 561 ACOs providing care to 10.5 million Medicare beneficiaries, the program has to date achieved marginal success.  Over four performance years (2013-2016), ACOs have saved substantially less than one percent of annual Medicare spending (now over $700 billion) - which is why the DHHS Secretary Alex Azar recently admitted candidly ACO performance has been "underwhelming" and "lackluster."  Even before the Medicare ACO program formally began there have been questions and criticism about the model's design.  Perhaps no one has written more about the model's flaws than Kip Sullivan.    

During this 32 minute conversation Mr. Sullivan discusses the genesis of ACOs including results from its predecessor, the Physician Group Practice demonstration, assumptions made in the the design of the model, e.g., the relationship between cost and quality and the effectiveness of financially incenting physicians, and moreover the problem of addressing care quantity instead of pricing.  In sum, Mr. Sullivan argues the Medicare ACO model is fatally flawed and will not achieve meaningful success. 

Mr. Kip Sullivan is currently a member of the board of the Minnesota chapter of Physicians for a National Health Program.  Mr. Sullivan began his career as a staff attorney for the New York Legal Aid Society and as a researcher for Citizens Action SullivanLeague in California.  Form 1980 through 2000 he researched universal health insurance and a single payer system for Minnesota COACT (Citizens Organized Acting Together).   He also served as a consumer representative on the Minnesota Governor's Health Plan Regulatory Reform Commission in the 1980s.  From 2000 to 2007 Mr. Sullivan was a health system analyst for the Minnesota Universal Health Care Coalition.  Mr. Sullivan has written over 150 health policy articles for the American Journal of Public Health, the Journal of Health Politics, Policy and Law, the LA Times, The Nation, The New England Journal of Medicine, The New York Times, and others.  He published 2006 "The Health Care Mess: How We Got Into It and How We'll Get Out of It."  Mr. Sullivan earned his undergraduate degree from Pomona College and his law degree the Harvard School of Law.   

Mr. Sullivan's latest essay, "Curb Your Enthusiasm," is at: http://thehealthcareblog.com/blog/2018/04/16/curb-your-enthusiasm/.

The Lawton Burns and Mark Pauly essay titled, "Transformation of the Health Care Industry: Curb Your Enthusiasm," in the the recent Milbank Quarterly, that is noted during this discussion is at: https://onlinelibrary.wiley.com/doi/full/10.1111/1468-0009.12312.

04/13/2018

Pediatrician Dr. Niran Al-Agba Discusses Gun Violence (Via In Part Her Columbine Experience) (April 12th)

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Including the February 14th shooting at Marjory Stoneman HS in Parkland Florida that killed seventeen students and teachers, there have now been over 130 shootings in elementary, middle and high schools in 43 states since 2000 and another 58 shootings in US colleges and universities.  Gun violence in this country is in a word, obscene.  It is, for example, 96 times higher than in Japan and 55 times higher in the UK.  It is largely explained by gun prevalence.  The US accounts for approximately five percent of the worldwide population, however, Americans own 42 percent of the world's guns.   What also explains gun violence is a federal policy that has persisted since 1996, the so called Dickey amendment, that prohibited federal funding to conduct gun violence research.   (Since 1996 there have been approximately 600,000 gunshot victims.)  The recently passed omnibus spending bill (that funds the federal government through this fiscal year) included accompanying report language stating the Dickey Amendment does not prevent federal agencies, moreover the CDC, from conducting gun violence research.  However, the spending bill included no money to conduct gun violence research.   

During this 28 minute conversation Dr. Al-Agba discusses her experience treating survivors of the 1999 Columbine High School shooting (that killed 13 and wounded 21), why the physician community has been hesitant to discuss gun safety with their patients and what can be done by the physician community to reduce gun violence, e.g., participating in student threat assessments.   

Dr. Niran Al-Agba is an a board certified pediatrician in private practice in Silverdale, Washington and is affiliated with Al-Agbamultiple hospital in the region including Harrison Medical Center and MultiCare Mary Bridge Children's Hospital and Health Center.  She is a her family's third generation physician practicing in the Kitsap County.  She is also an Assistant Professor on at the University of Washington School of Medicine and is a lead instructor at Seattle Children's Hospital for the past 15 years.  She has been voted the Best Doctor in Central Kitsap for three of the last six years.  She is the independent practice editor for the Health Care Bog, published on KevinMD and RebelMD, and pens a monthly column for her local newspaper, The Kitsap Sun.  Dr. Al-Abga received her medical degree from the University of Washington School of Medicine, did her residency at the University of Colorado School of Medicine/Denver Children's Hospital.  

Dr. Al-Abga's March 10th essay titled, "I Treated the Columbine Kids, I Have Not Spoken Before," noted during this discussion is at: http://thehealthcareblog.com/blog/2018/03/10/i-treated-the-columbine-kids-i-have-not-spoken-out-before/.