The Obama Administration is handing out waivers far and wide for its health-care bill, but behind the scenes the bureaucracy is grinding ahead writing new regulations. The latest example is the rule for Accountable Care Organizations that are supposed to be the crown jewel of cost-saving reform. One problem: The draft rule is so awful that even the models for it say they won’t participate.

The American Medical Group Association, a trade association of multispeciality practice groups and other integrated providers, calls the rule recently drafted by the Department of Health and Human Services “overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve.” In a survey of its members, 93% said they won’t enroll.

And no wonder, since the 429-page rule is a classic of top-down micromanagement. ACOs will need to comply with a kitchen sink of 65 clinical measures that are meant to produce efficiencies, like reducing infections or ensuring that patients take their medications after hospital discharge. If care at an ACO costs less than Medicare predicts it will cost under the status quo, then the ACO will receive a share of the savings as a bonus payment. The rule also includes financial penalties if an ACO misses its targets.

The irony, and maybe the tragedy, is that Paul Ryan’s Medicare reform plan is far more likely to drive more accountable care. Under his proposed premium support payments, seniors would be responsible for the marginal costs of their care, and we suspect most will choose more efficient providers. As these incentives start to change patient behavior and spread throughout the delivery system, the doctors and hospitals that offer a better value for the health dollar will succeed.

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