Sunday, October 24, 2010

Accountable Care Organizations: It's So Sad, It's Funny

Thanks to Scott Hensley over at Shots, NPR's Health blog, for highlighting this sad, but funny, video on where we're going with health care:

Scary what happens when theory meets reality.



medical blog said...

So true it's sad, so sad it's true. Same type of video can be made about meaningful use.

Gary M. Levin said...

Hey Dr Wes; I just posted some news about ACOs.....on my blog

DocTed said...

Your caption says it all.
Just a couple of comments. The bill as published is "only" 906 pages long and 2.3 MB in PDF.
An other "funny" thing about the bill is that it is almost all amendments to prior legislation including the Social Security act of 1935 itself and of course to Titles XVII (Medicare) and XIX (Medicaid) amendments to the Social Security Act.

Alex said...

Dr. Wes,

Thanks for sharing this video - your headline says it all.


Thanks for bringing up the issue of complexity. Unfortunately, you're understating things a bit. The health care reform law is actually two pieces of legislation: The Patient Protection and Affordable Care Act ("PPACA", Pub. L. 111-148), and the Health Care and Education Reconciliation Act ("HCERA", Pub. L. 111-152). Together, they total about 400,000 words: roughly the same length as Anna Karenina.

In addition to creating new complex legal regimes, they amend at least four existing complex legal systems: Medicare, Medicaid, employee benefits (ERISA), and the Internal Revenue Code.

Additionally, PPACA's Title X amends PPACA Titles I - IX, and HCERA amends those amended provisions. For example, the ACO provisions appear in PPACA secs. 3022 and 10307 (now Social Security Act Sec. 1899, to be codified at 42 U.S.C. 1395jjj).

As for ACOs themselves, the health care executive's confusion is actually somewhat justifiable: The Secretary of Health and Human Services (HHS) has extremely broad authority to issue regulations that govern: 1) Who can form an ACO; and 2) How the ACO will be reimbursed.

Without those regulations, no one can form an ACO without some significant risk that it may need to be completely revamped. HHS has yet to even propose regulations, so many people are in a holding pattern - but not for long: By statute, ACOs are supposed to start operating in 2012. Rumor has it that we may see some proposed regulations in the next month or two...

As for how ACOs might actually work, there's a short piece on my blog ( describing the general concept, but at this stage, it's impossible to know what exactly an ACO will be.

Alex said...
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