DJP Update 6-2-2011 evening edition: AMA Annual Meeting and resolutions – Keep your eyes on PPACA and individual mandate; consider definition of Liberty.
Government wants to pay for quality and not quantity, according to the advocates for PPACA. But the question I would like an answer to is: Who determines the quality? Will it be the patient armed with transparency and scientific information from readily accessible scientific experts and selecting the doctor the patient wants? Or will it be some panel appointed by the Executive Branch or Congress? Consider this for a moment. You have heard of the Medicare money penalty for readmissions to the hospital in the latest government plans. But how does that measure quality? With a monetary incentive not to admit the patient, who will track the patients who die because of failure to admit back into the hospital? Where is that monitored? Will there be lots of unintended consequences of the new law? I believe so.
Below is an article about the view of the MGMA regarding ACOs. ACOs are just one part of PPACA. The more the regulations come forth, the more are the problems. And wait until the world sees IPAB in action. I don’t think the history books will determine it to be just advisory. All of these issues are government central planning at its best.
The AMA Annual Meeting is coming up this month in Chicago. Regardless of decreasing AMA membership, perhaps less than 20% of practicing physicians, (I will be interested in the final tally) the fact remains that all of the state medical associations and the specialties are represented in the AMA House of Delegates. Make no mistake, the big debate will be on the new health care law, PPACA. There are competing resolutions for and against. The individual mandate is another subset that will be debated with great emotion. Visit the AMA Website if you are a member of AMA and review these resolutions. Be sure to read resolutions 109 advocating “Rescind” individual mandate, as well as others supporting the individual mandate, Res 114 and Res 102. There are others for you to review that give different views on the issue.
Don’t fail to read CMS Report 9 in Reference Committee A entitled “Covering the Uninsured and Individual Responsibility”
I find it interesting that the report states the individual responsibility requirement (DJP comment: of course this means individual mandate) “preserves individual liberty”.
EXCERPT from page 8 of CMS Report 9
DJP Comment: I disagree that the individual mandate preserves individual liberty.
As you have heard me say, at the microphone and in my writings, LIBERTY, by definition, is the absence of coercion.
If one uses incorrect definitions, it is possible to justify anything.
One reference re Liberty:
In his monumental work The Constitution of Liberty, F.A. Hayek and the discussion of “individual liberty” he says: “defining freedom as the absence of coercion…”
Of course we all know, the Supreme Court will make the final decision as to the constitutionality of the individual mandate. But in the meantime, we need to follow our AMA policy from the policy-making body of AMA, the House of Delegates. And when AMA makes policy, that on reflection, is not sound, or strays from policy, as some in the House of Delegates believe has happened with PPACA considered as a whole, then we need to fix it in the House of Delegates. We will have that opportunity to revisit current AMA policy, the individual mandate H-165.848, and decide if we wish to remove it. Mistakes can be made. It is wonderful to recognize mistakes and correct them. Even if the Supreme Court declares PPACA unconstitutional because of the individual mandate, we still will have our AMA policy unless we change it. If the policy cannot be implemented because the Court has said it is not allowed to mandate people in that manner, then the policy is no longer viable as a possible advocacy issue.
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Accountable Care Organizations in PPACA
http://www.modernphysician.com/article/20110601/MODERNPHYSICIAN/306019986
MGMA: ACO costs outweigh benefits under proposed CMS rule
By Andis Robeznieks
Posted: June 1, 2011 – 3:00 pm ET
Tags: Accountable Care Organizations, Costs, Medical Group Management Association (MGMA), Physicians
The CMS’ proposed rule (PDF) on accountable care organizations carries “excessively high” startup and operation costs relative to its “small and uncertain financial benefits” as well as “substantial regulatory risks” from the CMS inspector general’s office, the U.S. Federal Trade Commission and the U.S. Justice Department, according to formal comments filed by the Medical Group Management Association.
The Englewood, Colo.-based association’s comments also criticize the proposed rule’s attempts to link ACO implementation with federal programs promoting health information technology adoption.
“Medical groups already face a number of incentives or penalties associated with decisions to deploy or not to deploy healthcare information technology,” according to the association. “MGMA has urged the government in multiple forums to be realistic about the pace of (electronic health-record system) deployment, given the significant upfront and ongoing costs of those systems and the very real risks of ‘false starts’ with technology that may not be sustainable because of rapid product innovation and market dynamics.”
In addition to its eight-page comment letter to CMS Administrator Dr. Donald Berwick, the MGMA sent separate letters to the office of CMS Inspector General Daniel Levinson and FTC Secretary Donald Clark calling on the FTC and the Justice Department to “find a more streamlined method to screen proposed (ACO) collaborations so that the very process of seeking approval does not deter applicants.”
The MGMA has 22,500 members who manage some 13,600 medical organizations in which approximately 280,000 physicians practice.
Read more: MGMA: ACO costs outweigh benefits under proposed CMS rule – Modern Physician http://www.modernphysician.com/article/20110601/MODERNPHYSICIAN/306019986#ixzz1OBBXUFKB
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DJP NOTE: See Proposed Rule (128 pages) for ACO in Federal Register at government Website: http://edocket.access.gpo.gov/2011/pdf/2011-7880.pdf
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Have a great night!
Stay well.
Donald
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