Everyone knows that the excess growth in health care costs is driving the fiscal crisis in our country. The problem is that while everybody wants to somehow cut the cost of Medicare/Medicaid, in theory, when it comes time to actually make cuts, the courage of our politicians fails in the face of unrelenting public opposition to cuts in Medicare. How the IPAB takes policy and puts it in the hands of health care experts
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Accountable Care Organizations (ACOs) are supposed to be provider-led (physician groups +/- hospitals) and, they are supposed to inject a new accountability, at the provider level, for the value of services delivered. You know the old equation.  Value=Quality/Cost.  Those of us inside the health policy “beltway” know this mantra well. We have been talking about it for years (decades, really). I spent almost ...

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A recent blog post in Health Affairs proclaimed The End of Internal Medicine As We Know It.  What the article is really asking is the future of primary care in the world of health care reform and the creation of Accountable Care Organizations (ACOs). While doctors should be naturally concerned about change, I don't completely agree with this ...

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Recently, 47 American medical specialty societies sent Rep. Jim McDermott (D-WA) a letter, with copies to all members of Congress, containing a detailed defense of the American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC). For 20 years, the RUC has exclusively advised the Centers for Medicare and Medicaid Services (CMS) on physician procedure valuation ...

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I took my eye off the ball for just a little while, and guess what happened? When I looked again, I discovered that familiar solo practitioner or small group physician medical practices are on the verge of disappearing. Going the way of the dinosaur. At least, that's what the pundits are saying. In a recently published nifty newsletter, STAT Monthly, I read:

Primary care physicians and other specialists will continue to ...

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by Benjamin P. Geisler, MD, MPH Everybody is talking about Accountable Care Organizations or ACOs these days. The reason being that the Centers for Medicare and Medicaid Services or CMS has released the rules for shared savings between ACOs and CMS. The complete proposed rule is 429 pages long and they're seeking comments on it now until early June. What is an ACO? ACOs will take care of ...

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ACO regulations and related federal issuances hit the street, after several months of waiting -- from CMS, OIG, FTC, DOJ and IRS. They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to  limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt ...

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Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue - a practice called "self-referral" - unless the facility is located in their own practice. This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less ...

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An excerpt from Overhauling America’s Healthcare Machine: Stop the Bleeding and Save Trillions, published by Financial Times Press (2011).  Reprinted with permission of FT Press, and imprint of Pearson. In recent years, more and more of the revenue collected by U.S. healthcare facilities ends up paying for costs that have nothing to do with providing actual healthcare goods and services: things such as administration, billing, documentation, and the cost ...

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The Michigan Medical Group Managers Association had a conference recently in Mt. Pleasant, MI.  The theme of the conference was "Medical Management: Coaching Your Team to a Winning Season." Two speakers—Lloyd Carr, former head football coach of the University of Michigan Wolverines, and Lou Rabaut, partner of law firm Warner Norcross & Judd—both delivered excellent lessons on leadership.  Several of the ...

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