A Critique of Section 611(b) in Bernie Sanders’ “single payer” bill
Download a PDF of this report. Overview The most important defects in Bernie Sanders’ “single payer” bill, S 1804, are: The absence of budgets for institutional providers (hospitals and nursing homes) and clear authority to set uniform fee schedules for individual providers; and Section 611(b), which requires the maintenance of the “reform activities” authorized by […]
Understanding the Debate about Reducing Health Care Costs
Kip Sullivan, J.D. is a health policy expert and frequent blogger. He has been a Minnesota-based organizer and researcher on healthcare issues for more than two decades. Kip is the author of the book “The Health Care Mess: How We Got Into It and How We’ll Get Out of It.” His articles have appeared in […]
Why Do We Need ACOs and Insurance Companies?
Why Do We Need ACOs and Insurance Companies? Why does America need “accountable care organizations” as well as insurance companies? What is it that ACOs are supposed to do that insurance companies haven’t already tried? Whatever it is ACOs are supposed to be doing to lower costs, they aren’t succeeding. Kip Sullivan, J.D. is a […]
Would ACOs Work if They Were Turned into HMOs?
CMS has now conducted three demonstrations of the “accountable care organization,” and all of them have failed. The Physician Group Practice (PGP) Demonstration, which ran from 2005 to 2010, raised Medicare costs by 1.2 percent. [1] The Pioneer ACO program, which ran from 2012 through 2016, cut Medicare spending by three- …
How CMS Undermines ACOs and What to do About It
In my first post in this three-part series, I documented three problems with Pioneer ACOs: High churn rates among patients and doctors; assignment to ACOs of healthy patients; and assignment of so few ACO patients to each ACO doctor that ACO “attributees” constitute just 5 percent of each doctor’s panel. I noted …
ACO Turnover is High. Doctors Have Few Patients, and Those Patients are Unusually Healthy
ACOs suffer astonishingly high turnover rates among their doctors and patients; their patients are unusually healthy; and those unusually healthy ACO patients constitute about 5 percent of each ACO doctor’s panel of patients. These facts appear in three recent reports: CMS’s final evaluation of the Pioneer ACO program, and two papers …
Why We Have so Little Useful Research on ACOs
Our country urgently needs research on the impact of “accountable care organizations” on cost and quality. The ACO has been the establishment’s great hope for health care reform since the concept was invented at the November 9, 2006 meeting of the Medicare Payment Advisory Commission. If ACOs are not going to work, we …