As provisions such as the individual mandate and the new insurance exchanges have provoked a very public debate over President Obama’s healthcare law, policy experts have been anxiously watching the law’s lesser-known features aimed at making the system operate more efficiently. So far, the early results of the law’s experiments have been mixed.
In theory, entities known as accountable care organizations are supposed to steer the United States away from a system in which providers are merely paid for the amount of services they provide and toward one in which doctors and hospitals save money by coordinating care. The hope is that patients get the care they need while there is a reduction in unnecessary treatments.
From the get-go, the ACO experiments ran into problems. In 2011, renowned hospital systems such as the Mayo Clinic and Cleveland Clinic declined to participate in the Center for Medicare & Medicaid Services’ Pioneer ACO program, which was created to reward such systems that already pursue the type of integrated approach to medicine ACOs are trying to spread. CMS started with 32 Pioneer ACO participants, but 13 of them have since dropped out — leaving only 19 pioneers.
CMS recently released details on 2013, year two of the ACO program, claiming that the organizations improved on 28 of 33 quality measures and generated about $41 million in savings for the Medicare trust fund. But only 11 organizations — roughly a third of the original participants — achieved sufficient savings to qualify for the program’s bonus payments.
Another ACO experiment, known as the Medicare Shared Savings Program, has less rigorous requirements and attracted 220 participants. CMS reported that they had improved on 30 of 33 quality measures.
But Austin Frakt, a healthcare economist and assistant professor at Boston University, expressed skepticism about conclusions drawn from CMS performance data since it is not clear what they can be measured against.
“Remember, ACOs are self-selected,” he wrote on the Incidental Economist blog. “The right comparison group is unclear to me. Providers that chose to become ACOs might have improved their quality from year to year in the absence of the ACO model. How do we know what the ACO model is really doing?”
Critics of the healthcare law have argued that it places too many restrictions on participation in the program, and if the ACO model has any promise, experiments should be conducted at the private-sector level.
HHS guidance opens medical records to same-sex spouses
The Department of Health and Human Services Office for Civil Rights has issued guidance ensuring that same-sex spouses will be able to have the same rights to see their spouses’ medical information that are now granted to heterosexual married couples.
The ruling is an effort to square Health Insurance Portability and Accountability Act (HIPAA) regulations regarding medical privacy with a 2013 Supreme Court ruling striking down the part of the Defense of Marriage Act that restricted the federal government to recognizing only opposite-sex marriages.
Privacy rules allow relevant parties to share information about a patient’s care with family members in certain circumstances.
Under the new HHS guidance, for the purposes of such rules, “the term spouse includes individuals who are in a legally valid same-sex marriage sanctioned by a state, territory, or foreign jurisdiction (as long as, as to marriages performed in a foreign jurisdiction, a U.S. jurisdiction would also recognize the marriage). The term marriage includes both same-sex and opposite-sex marriages, and family member includes dependents of those marriages. All of these terms apply to individuals who are legally married, whether or not they live or receive services in a jurisdiction that recognizes their marriage.”
HHS’ Civil Rights Division promised to address the issue through further guidance or rulemaking in the coming months.
