CMS Listening, Trying with Adjustments to ACO Rules

Philip Betbeze, for HealthLeaders Media , May 20, 2011

However, commercial solutions are far from enough. For one, many of them seem to rely heavily on the idea that shifting more of the costs for care to the individual employee will help bring down healthcare costs. My answer is that yes, it probably will, but it’s too late, with the astronomical costs of basic healthcare, to count on the public to force down prices and improve quality simply because they have to pay for it.

Never mind the fact that even people with a commitment to good health will put off seeing their doctor because it’s too expensive. It’s like those dealer-funded oil changes that come with the purchase of a new car. If oil changes cost several hundred dollars instead of $30 or so after the dealer incentive runs out, do you think lots of people would stretch their oil to the breaking point? They would, and they will with healthcare too.

But before I get too far off track, the good news is that CMS seems willing to adjust, and so do providers, who are certainly interested in finding different ways to improve reimbursement for the good work they do. 

Sure, CMS must deal with different challenges than private businesses in negotiating solutions that will be different enough to entice providers to participate -- from the physician office level to the multi-hospital health system. In this case, CMS could learn a valuable lesson from commercial insurers: It takes a variety of possible solutions requiring constant -- or at least regular-- adjustments, to achieve the goal of lowering costs and improving quality.

WEBCAST: Effective ACO & Clinical Integration Strategies
June 7, 2011 at 1:00 PM ET
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Philip Betbeze is senior leadership editor with HealthLeaders Media.

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