Saturday, January 21, 2012

A bad report card for Medicare's pilot projects

---according to a CBO study as reported in this Medscape piece:

Most Medicare demonstration projects aiming to reduce costs and improve the quality of care — prime goals of healthcare reform — miss their mark, according to a new study from the Congressional Budget Office (CBO) published online Wednesday.

The projects consisted of numerous P4P schemes, disease management programs and bundled payments. The whole thing was a bust with the exception of one bundled payment project for CABG patients which saved money. (Well, after all if you pay less it'll cost less, won't it?).

It brings to mind some of the lessons we learned from managed care a decade ago. Managed care was a smashing financial success simply because they refused to pay for stuff. It was short lived. After a public backlash managed care “matured” and focused on integration of services and “quality.” The cost benefits waned and there was no demonstrable gain in real quality that could be directly attributed to managed care.

I could go on but take a look at what DB had to say about the report:

Boys and girls, this stuff is much more complex than these demonstration projects can address. Physicians really do their best out there.

One of his commenters said it better that I could:

Pretty much destroys a lot of the assumptions used to promote ACOs and PCMHs. I doubt if the true believers will pay any attention to this report.

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