Re: New on PTManager Blog: ACOs

[Guest guest]

Little by little, more and more will be controlled by fewer and fewer.

New on PTManager Blog: ACOs

Your Daily Posterous Spaces Update December 1st, 2011 Not Running

a Hospital: Let's wake up about

ACOs<http://ptmanagerblog.com/not-running-a-hospital-lets-wake-up-about-aco>

Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT,

MSA <http://posterous.com/users/1l1oCkDWEWjv> to

PTManager<http://ptmanagerblog.com>

[image: Like this

post]<http://posterous.com/likes/create?post_id=82860578>

Let's wake up about ACOs

Comments by two folks recently should reawaken our concern about how to

hold accountable care organizations accountable and whether creation of

ACOs will lead to market dominance that will not bring value to patients.

Back in 2009, I

noted<http://runningahospital.blogspot.com/2009/06/how-do-you-make-aco-accountab\

le.html>

:* *

*Here in Massachusetts, there is only one such entity that approaches the

definition of an ACO, Partners Healthcare System. But there is no sign that

it has used its size and scale to deliver care at a lower cost. Indeed,

there is

evidence<http://www.boston.com/news/health/articles/2008/11/16/a_healthcare_syst\

em_badly_out_of_balance/>that

it has used its market power to extract higher rates from insurance

companies. Likewise, there are no data to show that quality, safety, and

efficacy in the delivery of care throughout the Partners system is better

than other community hospitals or academic medical centers.*

Indeed, a recent

post<http://runningahospital.blogspot.com/2011/11/this-is-not-about-tiered-healt\

h-plans.html>suggests

that such economies may be at risk in ways I hadn't considered.

Now, see these

comments<http://thehealthcareblog.com/blog/2011/11/23/ftc-commissioner-accountab\

le-care-organizations-will-likely-lead-to-higher-costs-and-lower-quality-health-\

care/>from

Federal Trade Commissioner J. Rosch, as reported by Avik Roy on

The Health Care Blog:

*“The net result†of ACOs, says Rosch, “may therefore be higher costs

and

lower quality health care—precisely the opposite of its goal.â€*

*Rosch notes that the Centers for Medicare and Medicaid Services (CMS) have

been running an ACO demonstration project, called the Physician Group

Practice Demonstration, for several years now. “The results were nothing to

crow about,†says Rosch. “Even after five years of the project, a majority

of the participating practice groups did not achieve any cost savings.â€*

*In theory, the Federal Trade Commission has the authority to challenge

monopolistic hospital mergers. But in 1996, the FTC’s policies on health

care mergers were amended <http://www.ftc.gov/opa/1996/08/hlth3.shtm> to

provide a safe harbor to competing hospitals that achieved sufficient

clinical integration. “I thought then, as an antitrust practicioner who

frequently represented health care providers, that the 1996 amendments…were

the biggest loophole in the antitrust laws I had seen,†says Rosch.

“Subsequent Advisory Opinions issued by Commission staff…were about as

clear as mud.â€*

Now, look at the

remarks<http://www.boston.com/Boston/whitecoatnotes/2011/11/michael-dukakis-acos\

-tried-that-folks-didn-work/SuSu6y1FtBQAfNSKRgKORJ/index.html>from

former Massachusetts Governor Dukakis, who, you might

remember, introduced the first universal health care law to the state

several decades ago. Whether you agree with his remedy or not, it is

prudent to regard his warning carefully:

*Speaking during the Harvard School of Public Health Voices from the Field

series<http://www.hsph.harvard.edu/translation/decision-making-voices-from-the-f\

ield/>,

Dukakis said urging the health care market to fix itself is “a colossal

waste of time.â€*

* *

*“If the market doesn’t work you have to regulate,†he said.

“R-E-G-U-L-A-T-E. Thoughtfully, responsibly, and with the active

involvement of all of the people who provide health care and who are very

important to us.â€*

*ACOs and global payments. What did we used to call them? HMOs and

capitation. We tried that, folks. It didn’t work. Why are we doing it again?

*

I have noted before that public policy formulation in the health care arena

is characterized by a striking lack of

rigor<http://runningahospital.blogspot.com/2011/07/off-base-optimism-part-1.html\

>.

Here are two experts in the field who are urging us to be cautious about

basing the new design of health care on a wish and a prayer. It is

interesting to ask why they are being ignored. Can it be that those with

market power in this field have seen a answer to *their* problems, as

opposed to ours?

Posted by Levy at 11/30/2011 06:12:00

AM<http://runningahospital.blogspot.com/2011/11/lets-wake-up-about-acos.html>

via

runningahospital.blogspot.com<http://runningahospital.blogspot.com/2011/11/lets-\

wake-up-about-acos.html>

Google Reader (91) <http://ptmanagerblog.com/google-reader-91>

Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT,

MSA <http://posterous.com/users/1l1oCkDWEWjv> to

PTManager<http://ptmanagerblog.com>

[image: Like this

post]<http://posterous.com/likes/create?post_id=82860613>

Can Physical Therapists Replace Physicians as Primary Care Providers in

Hospitals?

<http://feedproxy.google.com/~r/EvidenceInMotion/~3/iAshSthjGPk/can-physical-the\

rapists-replace-physicians-as-primary-care-providers-in-hospitals.html>

from MyPhysicalTherapySpace.com by Tim , PT

Doom-and-gloom futurists project a " doctor shortage " in the United States

but new studies increasingly support the roll of non-physician providers in

primary care settings, such as hospitals.

A recent study in the December 2011 Health Services

Research<http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01324.x/abs\

tract>found

that direct access to physical therapists is associated with lower

costs and fewer visits and suggests that...

* " ...the role of the physician gatekeeper in regard to physical therapy may

be unnecessary in many cases. " *

Patient satisfaction is driven by clinicians who do the following:

1. spend more time with patients

2. listen more closely

3. provide more feedback

4. show more respect for patients' opinions

Time spent with the patient AND cultural competency were both factors in a

small study

<http://aanponline.org/abstract/ViewAbstract.aspx?ID=1080>presented

in June 2011 at the American Academy of Nurse Practitioners

(AANP) 26th Annual Meeting in Las Vegas.

The survey of just under 200 patients found that only 50% of physicians'

patients reported that they felt that doctors " always " listened carefully,

compared with more than 80% of nurse practicioners patients.

Physicial therapists are trained in listening to patients and in cultural

competency. I would like to see this study repeated - comparing physical

therapists' patients to physicians' patients.

The forces driving increased utilization of non-physician care givers are

not just based on quality and licensure. Cost is also causing hospitals to

consider nurses, physician assistants and physical therapists in primary

care roles.

An October 2011 study in Nursing

Economics<https://www.nursingeconomics.net/ce/2013/article3001021.pdf>examined

nursing versus physician outcomes over an 18-year period and found

the following:

* " ...patient outcomes of care provided by nurse practitioners and certified

nurse midwives in collaboration with physicians are similar to and in some

ways better than care provided by physicians alone for the populations and

in the settings included. " *

This Data Brief from the Centers for Disease Control and

Prevention<http://www.cdc.gov/nchs/data/databriefs/db77.htm>(CDC)

shown that, despite regulatory and licensure barriers erected by

state medical societies, hospitals are pushing the boundaries of

non-physician scope of practice by hiring nurses and physician assistants

for primary care roles at increasing rates.

<http://4.bp.blogspot.com/-jpPKYGwBDzQ/TtNenyVDyOI/AAAAAAAAAcg/R8ELNsh-fck/s1600\

/arnp_hospital.png>

* " This analysis shows that visits to Physician Assistants (PA) or Advanced

Practice Nurses (APN) have become more common in hospital outpatient

departments over the past decade.*

...Visits seen only by a PA or APN continue to be higher in rural areas. In

addition, a higher proportion of visits to PAs or APNs occur with younger

patients. "

The American Physical Therapy Association

(APTA)<http://www.apta.org/Blogs/MovingForward/2011/11/23/>is

examining ways that physical therapists can find opportunities in

these

primary care settings. Listen to this 11-minute podcast

<http://www.apta.org/Podcasts/>called *Expectations of a Physical Therapist

in the Emergency Department* (member log-in required) to learn about

expanded practice oppotunities.

The doom-and-gloom futurists have got it wrong, I think. There will NOT be

a doctor shortage of the magnitude predicted. If anything, the shortage of

physical therapists will only increase.

Now, how do we square THAT circle for my private practice physical

therapist brothers and sisters?

Tim , PT

via

google.com<http://www.google.com/reader/view/#stream/user%2F08170950267104389123\

%2Flabel%2FHealthcare>

Self-referral may lead to more negative exams for

patients<http://ptmanagerblog.com/self-referral-may-lead-to-more-negative-exams>

Posted about 11 hours ago by [image: _portrait_thumb] Kovacek,

PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to

PTManager<http://ptmanagerblog.com>

[image: Like this

post]<http://posterous.com/likes/create?post_id=83100559>

Self-referral may lead to more negative exams for patients

[image: Submit a Comment] Submit a

Comment<http://www.orthosupersite.com/view.aspx?rid=89897#submitComment>

[image:

Print]

Print<http://www.orthosupersite.com/view.aspx?rid=89897/print.aspx?rid=89897>

[image:

Email this page to a friend]

E-mail<http://www.orthosupersite.com/view.aspx?rid=89897/sendResource.aspx?rid=8\

9897>

[image:

AddThis]<http://www.addthis.com/bookmark.php?v=120 & winname=addthis & pub=OrthoSupe\

rsite & source=men-120 & lng=en & s= & url=http%3A%2F%2Fwww.orthosupersite.com%2Fview.as\

px%3Frid%3D89897 & title=Self-referral%20may%20lead%20to%20more%20negative%20exams\

%20for%20patients & logo= & logobg= & logocolor= & ate=AT-OrthoSupersite/-/-/4ed6ebe3427\

3ecfa/1 & frommenu=1 & uid=4ed6ebe318dc0830 & tt=0>

[image: Ben E. Paxton, MD]

*Ben E. Paxton*

Physicians who have a financial interest in

imaging<http://www.orthosupersite.com/searchResults.aspx?partialfields= & cx= & q=im\

aging & client=common_frontend & output=xml_no_dtd & proxystylesheet=common_frontend & g\

etfields=MediaType.PostedDate & filter=0 & sort=date & requiredfields=projectID%3A19 & s\

ite=default_collection & x=9 & y=2imaging>equipment

are more likely to refer their patients for potentially

unnecessary imaging exams, according to a study presented at the 2011

Annual Meeting of the Radiological Society of North America.

“Self-referred<http://www.orthosupersite.com/searchResults.aspx?partialfields=\

& cx= & q=self-referred & client=common_frontend & output=xml_no_dtd & proxystylesheet=co\

mmon_frontend & getfields=MediaType.PostedDate & filter=0 & sort=date & requiredfields=p\

rojectID%3A19 & site=default_collection & x=9 & y=2self-referred>medical

imaging has been shown to be an important contributor to escalating

medical costs,†Ben E. Paxton, MD, stated in a Radiological Society of

North America news release.

The researchers studied if use of lumbar spine MRI differed depending on

the financial interest of the physician ordering the exam. According to the

release, the team reviewed 500 consecutive diagnostic lumbar

spine<http://www.orthosupersite.com/searchResults.aspx?partialfields= & cx= & q=lumb\

ar+spine & client=common_frontend & output=xml_no_dtd & proxystylesheet=common_fronten\

d & getfields=MediaType.PostedDate & filter=0 & sort=date & requiredfields=projectID%3A1\

9 & site=default_collection & x=9 & y=2lumbar+spine>MRI

exams ordered by two groups of orthopedic physicians serving the same

community. The first group had a relevant financial interest in the MRI

equipment used, while the second group had no such interest.

Story continues below<http://www.orthosupersite.com/view.aspx?rid=89897#jump>

↓

ADVERTISEMENT

'+bgo+ 'Embedded media -- click here to see

it.<http://ptmanagerblog.com/self-referral-may-lead-to-more-negative-exams>

[image:

Advertisement]<http://adclick.g.doubleclick.net/aclk?sa=L & ai=BPQe05uvWTsSQK4yusQ\

eorPHuDZnD2O8BAAAAEAEgweHKBzgAWNGj17MZYMn2t4mQpOgPsgEWd3d3Lm9ydGhvc3VwZXJzaXRlLm\

NvbboBCWdmcF9pbWFnZcgBCdoBMWh0dHA6Ly93d3cub3J0aG9zdXBlcnNpdGUuY29tL3ZpZXcuYXNweD\

9yaWQ9ODk4OTfgAQTAAgLgAgDqAhxPUlRIT19JbWFnaW5nX0xhcmdlUmVjdGFuZ2xl-AKB0h6QA6QDmA\

OkA6gDAdAEkE7gBAGgBh4 & num=0 & sig=AOD64_0q1S2xdsoZYiaYLIVztVoHhy8TPg & client=ca-pub\

-0829525646633902 & adurl=http%3A%2F%2Fad.doubleclick.net%2Fclick%253Bh%253Dv8%2F3\

bd0%2F3%2F0%2F%252a%2Fg%253B243484174%253B0-0%253B0%253B65555588%253B4307-300%2F\

250%253B43008178%2F43025965%2F3%253B%253B%257Esscs%253D%253fhttp://www.xareltohc\

p.com/index.html?utm_source=OrthoSuperSite.com%20ROS & utm_medium=Banner & utm_conte\

nt=300x250 & utm_campaign=Now%20Available%20-%20ORS>

Abnormalities per positive scan, mean age of patients and negative exam

result rates were all analyzed. Among the 500 MRI exams — 250 per group —

the researchers found no significant difference in the number of

abnormalities per positive scan. However, they noted the mean age of

patients in the group with financial interest was 49.6 years, compared with

an average age of 56.9 years for patients under the group of physicians

without financial interest.

The authors found that the group of physicians with financial interest

reported 86% more negative scans than the group of physicians without

financial interest. Of 163 negative exams in the study, 106 belonged to the

group with financial interests. Forty-two percent of patients referred for

exams by physicians with financial interest demonstrated negative scans,

compared with 23% of patients under the care of the physicians without

financial interest.

“Orthopedic surgeons with financial interest in the equipment had a much

higher rate of negative lumbar spine MRIs,†Paxton stated in the release.

“In addition, they were much more likely to order MRI exams on younger

patients. This suggests that there is a different clinical threshold for

ordering MRI exams in the setting of financial incentivization.â€

*Reference: *

- Paxton BE, Lungren MP, Jung S, et al. A case study in lumbar spine MRI

and physician self-referral imaging. Paper SSK08-07. Presented at the 2011

Annual Meeting of the Radiological Society of North America. Nov. 27-Dec.

2. Chicago.

via orthosupersite.com <http://www.orthosupersite.com/view.aspx?rid=89897>

[image: Posterous] <http://posterous.com> Want your

own?<http://posterous.com> Change

your email

settings<http://posterous.com/email_subscriptions/hash/gspsqucxgqviGogjvCufJwAxB\

xkgmH>