Follow me
Tag Archives: ACOs
Should Emergency Medicine be Carved Out of Payment Reform?
Should emergency physicians advocate that they be carved-out of payment reform? There may be no easy answer to this question, at least not yet; and in any case, advocating to be an exception to the transition from fee-for-service to pay-for-performance and risk-sharing may be a waste of time and effort. The tide is clearly turning, though not as quickly as payers and government regulators might wish; and it would appear that eventually, every physician and … Continue reading
The Future of Health Care – Crystal Ball Gazing Over Breakfast
Yesterday I attended a two and a half hour breakfast conference in San Francisco on The Future of Healthcare, at the kind invitation of City National Bank, one of the sponsors. The conference featured George Halverson, the Chairman and CEO of Kaiser Foundation Health Plan, Wright Lassiter, the CEO of Alameda County Medical Center, a safety net hospital , Cal Knight, President and CEO of John Muir Health (a large community hospital based company in … Continue reading
What is Cost-effective Care?
Lately I have been pondering the question of how to identify cost-effective ways to manage patients in the ED. I have concluded that before I could identify evidence-based cost-effective approaches to care, I first had to define what cost-effective care means. It could mean an approach that is focused just on the cost of care in the ED; or it could mean the costs of care for an episode that extend beyond ED services to … Continue reading
Episodes of Care for Emergency Medicine
Recently, a question was forwarded to me from a member of the ACEP task force that is the 2011 extension of last year’s Value Based Emergency Care Task Force: has anyone yet developed any draft Episodes of Care for Emergency Medicine? Personally, I do not know of anyone who has developed EOCs for EM. My guess is that many are waiting for ACEP’s task force to take a crack at this first. One of the … Continue reading
PPACA, Medical Loss Ratios, and Capitation – a Loop Hole Big Enough to Drive an Armored Truck Through
One of the new health reform provisions in the PPACA regulations is a requirement for health insurers to spend a certain proportion of health insurance premiums on actual medical care, thus limiting to some extent the proportion of these premiums that can be allocated to administrative expenses and profits. This proportion is called the medical loss ratio (MLR), and in the regs the proportion that must be spent on care is 85% or higher in … Continue reading