Saturday, October 12, 2013

Twinkies and Ding Dongs Democrats or Republicans


Republicans, or Democrats.  Who is the Twinkie and who is the Ding Dong?

Depending upon whom you ask the PPACA is the best thing since the advent of the Twinkie. And although PPACA passed congress we are not certain how it will survive. It will survive as the Twinkie and the Ding Dong are surviving despite skeptics and outright hostility from some quarters.

What about some bi-partisan support and remediation by Republicans and Democrats, alike?

Physician medical groups seem the happiest of all segments of medicine.

Don Crane, the CEO of CAPG (California Association of Physician Groups) in the December issue of their newsletter had this to say in 2010.

“As we watched the election results, it became clear that the Accountable Care Act (ACA) is, in fact, established policy. Regardless of our political views, we now have a more accurate picture of what the future holds for physician groups. At last we can put long-term planning back on the table and base our decisions on fact instead of speculation. That is good new”

Don Crane sees the big picture overall as he eloquently and accurately states,

“The most urgent issues facing our country are the deficit and the federal budget,

and both will have a huge impact on the healthcare community. The sustained

growth rate (SGR) provider payment measurement, which dates back to 1997 when

spending costs were increasing much more slowly, will probably get another

“patch.” That isn’t enough. What it needs is a genuine and lasting “fix” that includes

incentives for coordinated care, primary care and Accountable Care Organizations

(ACOs). We will continue to press for those kinds of improvements to the ACA. Another critical issue associated with the ACA is the expansion of healthcare coverage to 32 million million uninsured. It will be costly, and implementation may be difficult. In California, however, voter-approved Proposition 30 provides additional taxes which should prevent serious cuts to Medi-Cal.”

Don Crane summarized well in the newsletter,

“I expect to see an acceleration of the mergers and acquisitions trend, with well managed physician groups among the most sought-after entities. CAPG physician groups and others practicing in our accountable care model know how to provide better care at lower costs. They know how to measure and improve clinical quality. They know how to establish effective management. Those who also understand how to adapt and innovate in a new environment will be among the success stories of the next decade”

Managers love to manage, and the bigger the group they manage the greater their esteem. It’s a little bit like government.

Physician medical groups will adopt quickly to ACA and even possibly to the ACO concept. Small medical practices, individual solo practices will struggle with much more, setting up an organization. Much of the transition has to do with infrastructure and professional management.

HHS says that ACOs will create great cost saving measures, and improve quality of care. Both claims will require some hard evidence. These early claims are based upon already formed large medical group systems (already in place) with very early statistical evidence for a short time period.

Engaging small systems will require careful and prudent management. In a sense this is a new enterprise model, subject to all of the vagaries of all startups. Management costs, health information technology, and capital requirements could tip the balance into insolvency very quickly.

The incentives offered by HHS for adoption of EHR are misleading and do not allow for continuing maintenance, nor software updates. It is well known that EHR hardware and software maintenance costs over the long run far exceed the capital expenditure to purchase a system.

Of course all of this was before “Sequestration” precipitated by the debt crisis. There is much uncertainty as to how this will be implemented for Medicare plans.


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