Tuesday, January 27, 2015
This is, or at least may be, a BFD
I have discussed initiatives in the Affordable Care Act that encourage experimentation with new ways of reimbursing health care providers --Accountable Care Organizations being the most noteworthy. These are capitated (i.e. paid a lump sum per year per patient, with some adjustments) multi-specialty provider entities that get bonuses for patient satisfaction and good outcomes and get their pay docked for bad outcomes. But, these are just experiments that will only have a few takers.
But now the Administration has announced a major change in Medicare. By then, 30% of payments will be under ACO-like alternative pay models. A total of 85% of Medicare payments will be tied to outcomes in some way by 2016. Right now, most doctors are paid to do stuff, which means they do too much. They are paid even more if the stuff they do actually harms you and you need more care to fix it. (That happened to me: I underwent a right hemicolectomy, leading to what would be more than a hundred thousand in current dollars, when all I had was diverticulitis.)
We'll see if this really happens, and how well it works. But it's a revolution.