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5 posts from April 2016


Daniel Dawes Discusses His Recent Book,"150 Years of Obamacare" (April 27th)

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Since, in part, April is recognized by DHHS as National Minority Health Month (this year's theme is "Accelerating Health Equity in the Nation") it is thoroughly appropriate to discuss Professor Daniel Dawes's recent work, "150 Years of Obamacare."  Professor Dawes's work begins with a discussion of efforts since the Civil War to reform national health care policy beginning with the 1865 Freedmen's Bureau Act.  The work moreover provides an accounting of his and others efforts to lobby successfully for health equity provisions in passing the 2010 Affordable Care Act ( ACA).  

During this 31-minute conversation, Professor Dawes discusses passage of the ACA, i.e., "Obamacare,", e.g., Republican opposition to the legislation and moreover the importance of the sixty plus health equity-related provisions in the legislation and what are his priorities for furthering health care equity or reducing disparities in health care delivery and outcomes - that sadly remain pronounced.   

Attorney and Professor Daniel E. Dawes is the Executive Director of Health Policy and External Affairs at the Morehouse Dawes_daniel_credit_brigette_martin_mackSchool of Medicine and a Lecturer within Morehouse's Satcher Health Leadership Institute and the Department of Community Health and Preventive Medicine.  He founded and chairs the Working Group on Health Disparities and Health Reform and is the co-founder of the Health Equity Leadership and Exchange Network (HELEN).  Previously, Professor Dawes held positions with the Premier Healthcare Alliance, the American Psychological Association and served on the Senate HELP (Health, Education, Labor and Pensions) Committee under Senator Edward Kennedy.   He is the recipient of numerous award including the Congressional Black Caucus Leadership and Advocacy Award.  He earned his JD from the University of Nebraska and his BS from Nova Southeastern University.

For more information concerning Professor Dawes's work, go to: https://jhupbooks.press.jhu.edu/content/150-years-obamacare.  


Operational Challenges Associated with Accountable Care Organizations (ACOs): A Conversation with Dr. Richard Morel (April 21st)

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As a follow up to my April 1st conversation with Jim Gera concerning bundled payments, during this podcast Dr. Richard Morel discusses Medicare's other major payment reform program, Accountable Care Organizations (ACOs), or WESTMED Medical Group's three year experience as a Track 1 ACO.   The Medicare ACO program is a creation of the 2010 Accountable Care Act and participation in the program began in 2012.   Currently, there are 434 ACOs (over 90 percent participating in the "no risk" Track 1) caring for approximately 7.5 million Medicare beneficiaries.  The program to date has been a mixed success.  After two performance years (2013 and 2014) only 25 percent of participants have been successful, i.e., have earned shared savings.  (Performance year three or 2015 performance will be made known this September.)  CMS is currently in the process of revising how the agency calculates an ACO's reset financial benchmark.  It is anticipated these changes will improve program performance, or improve both provider interest in participating (or continuing to participate) in the program and participant success in earning shared savings.   

During this 21-minute conversation Dr. Morel provides an overview of WESTMED, explains the organization's interest in becoming a Medicare Shared Savings Program or ACO participant in 2013, WESTMED's experience under their first three year agreement, what explained their success, challenges they've found with the program, how the program could be improved and their expectations now as a second agreement period Track 1 ACO.

Dr. Richard Morel is the Co-Medical Director of WESTMED Medical Group in Yonkers, New York.  Prior to joining WESTMED in 2008 Dr. Morel WESTMEDDr RichardMorel (2)was in private practice affiliated with Columbia-Presbyterian Riverdale Hospital for 12 years.  Dr. Morel is board certified in internal medicine.  He received his medical degree from Columbia University College of Physicians and Surgeons, did his postgraduate training at Columbia-Presbyterian Medical Center and  received his masters of medical management from Carnegie Mellon.  He is a fellow of the American College of Physicians and a member of the American College of Physician Executives.  

For information regarding WESTMED go to: http://www.westmedgroup.com/.



What Might We Expect in the MACRA Proposed Rule? (April 11th)

For those following Medicare payment reform last April the MACRA (Medicare Access and CHIP Reauthorization Act) was passed by Congress and signed into law by the President.  Title I of the law reforms how Medicare physician payments are annually updated, i.e., the law replaces the 1997 Sustainable Growth Rate.  The proposed MACRA rule, that CMS will publish sometime over the next few to several weeks, is highly anticipated because beginning in 2019 physicians and other eligible professionals can face significant increases or decreases in their annual payment update depending how they perform on quality and/or value under the two MACRA-created payment update pathways: MIPS (the Merit-based Incentive Payment System) and APMs (Alternative Payment Models).  If you're interested in theses provisions of the law and what we might see in the proposed rule, feel free to read this essay posted April 6th on The Health Care Blog.  





Accountable Care and Elective Joint Replacement Comment Letters (April 5th)

If you're interested in the Medicare Accountable Care Organization program, CMS published a proposed rule in January to revise how the agency calculates ACO financial benchmarks.   And/or, if you're interested in bundled payment arrangements for hip and knee replacement surgeries  (the topic of the Jim Gera interview), here are two related comment letters.  The first is addressed to CMS in response to their ACO proposed rule and the second is addressed to the HCP LAN (Health Care Plan Learning Action Network) concerning their elective joint replacement white paper.  I drafted these for the AMGA. 






How Orthopedic Bundled Payments Are Being Operationalized: a Conversation with Jim Gera (April 1st)

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Today, CMS launched the agency's second bundled payment demonstration, a mandatory five-year initiative in approximately 800 hospitals nation-wide.  It's titled, the Comprehensive Care for Joint Replacement (CJR).  The CJR essentially reimburses hospitals a predetermined amount for a 90-day hip or knee surgical and rehab episode of care.  CMS is emphasizing hip and knee replacement surgeries because they account for the single largest Medicare dollar amount and highest percent of annual 30 day episode spending.  This demonstration follows CMS's voluntary Bundled Payment for Care Improvement (BPCI) demonstration that provides bundled payments for 48 care episodes (including hip and knee replacements) via four care model designs.  How successfully hospitals, orthopedic surgeons and various post acute providers manage these care episodes will be important if CMS is to better control Medicare spending growth.   (Listeners will recall I discussed moreover the theory of bundled payment arrangements with Harold Miller this past September 23rd.)  

During this 29 minute conversation Mr. Gera provides and overview of Signature Medical Group and their orthopedic bundled payment work under both CMS's BPCI and CJR demos.  More specifically, he discusses how hip and knee replacement surgical patients are identified, how the bundled payment care team is assembled, how the care episode is manged, how quality is measured, profit sharing conducted and moreover principles his organization has developed to succeed under these capitated payment arrangements.  

Mr. Jim Gera is the Senior Vice President of Business Development for Signature Medical Group, Inc., a multi-specialty group Searchof physicians located in St. Louis and rural Missouri.   Among other related activities Mr. Gera co-authored an Advanced Payment Medical Accountable Care Organization application and a successful CMS Strong Start for Mothers and Newborns grant award.   Recently he has also served as a Chair for several CMS innovation grant reviews.  Mr. Gera's previous experience includes working with other physician group practices, in outpatient facilities and in managed care both in Medicare Advantage and Special Needs Plans.  Mr. Gera received his MBA from Southern Illinois University at Edwardsville.

For more on CMS's CJR demonstration see:  https://innovation.cms.gov/initiatives/cjr

For more on Signature Medical Group see: http://www.signatremedicalgroup.com/