Owing to their complex nature it is very hard for ACOs to be financially and clinically successful. In part this is because the program is largely closed off from the types of innovation and work flows that could hardwire ACOs to bud, evolve and improve. Rather than introducing a good model and letting industry iterate around it in a hundred different ways, the government too tightly defined exactly how an ACO must form and operate.For example, as they stand now, rules require that ACOs be at least 75% provider-controlled, so physicians must do the heavy lifting when starting one. The reality is that, once formed, an ACO requires extensive management, technical resources and granular insight into, and analysis of, patient data. Many of these requirements are beyond the realm or interest of your average physician. That’s made some independent physicians flee to hospitals and large health systems for employment, an avenue they see as their only way into shared savings models. This rampant physician employment trend is not only reducing patient choice in health care, it is also driving up cost–the very opposite of the intended effect of ACOs.
The Political Roots of Health Insurance Benefit MandatesDouglas Webber, James Bailey | May 28, 2014
As of 2011, the average US state had 37 health insurance benefit mandates, laws requiring health insurance plans to cover a specific treatment, condition, provider, or person. This number is a massive increase from less than one mandate per state in 1965, and the topic takes on a new significance now, when the federal government is considering many new mandates as part of the “essential health benefits” required by the Affordable Care Act. A large body of literature has attempted to evaluate the effect of mandates on health, health insurance, and the labor market.
However, previous papers did not consider the political processes behind the passage of mandates. In fact, when they estimate the laws’ effect, almost all papers on the subject assume that mandates are passed at random. We use fixed effects estimation to determine why some states pass more mandates than others. We find that the political strength of health care providers is the strongest determinant of mandates. Our paper opens the way to estimating the causal effect of mandates on health insurance and the labor market using an instrumental variables strategy that incorporates political information about why mandates get passed.
This paper estimates the effect that premiums in Medicaid have on the length of enrollment of program beneficiaries. Whether and how low income-families will participate in the exchanges and in states’ Medicaid programs depends crucially on the structure and amounts of the premiums they will face. I take advantage of discontinuities in the structure of Wisconsin’s Medicaid program to identify the effects of premiums on enrollment for low-income families. I use a 3-year administrative panel of enrollment data to estimate these effects. I find an increase in the premium from 0 to 10 dollars per month results in 1.4 fewer months enrolled and reduces the probability of remaining enrolled for a full year by 12 percentage points, but other discrete changes in premium amounts do not affect enrollment or have a much smaller effect. I find no evidence of program enrollees intentionally decreasing labor supply in order to avoid the premiums.
David A. Hyman is the H. Ross & Helen Workman Chair in Law and director of the Epstein Program in Health Law and Policy at the University of Illinois Urbana-Champaign, as well as an adjunct scholar at the Cato Institute. Earlier this month, Hyman gave the following erudite presentation on the implementation of the Patient Protection and Affordable Care Act – which he calls PPACA, not “ObamaCare” or “the Affordable Care Act” – at a faculty seminar hosted by the University of Chicago’s MacLean Center for Clinical Medical Ethics.
When It Comes to Cost and Quality of Hospital Care, Nurse Tenure and Teamwork Count – Robert Wood Johnson FoundationMay 28, 2014
Researchers found that a one-year increase in the average tenure of registered nurses RNs on a hospital unit was associated with a 1.3 percent decrease in the average length of stay.The study also found that patients’ length of stay was longer when a member of a team of experienced RNs was missing or a new member was added to the team. Stone, one of the principal investigators, notes that “when the same team of nurses works together over the years, the nurses develop a rhythm and routine that lead to more efficient care.”
PELOSI: How to “fix” Obamacare? SINGLE-PAYER
Much attention has been recently devoted to changing the first two years, but equal attention must be given to improving the experience during the third and fourth years. Clinical rotations teach medical students to integrate their knowledge and adapt it to the unique circumstances and needs of individual patients. It is this ability that separates physicians from other medical professionals, and as such the cultivation of this ability should be the foremost goal of medical education. Just like medicine itself, changing conditions in the world of medical education lead to the emergence of unanticipated new problems over time, which can only be addressed if we are willing to adapt our practices as we begin to understand the origins of these problems.