Accountable Care Organisation (ACO) model provides quality health care at moderate costs. Ireland's regional hospital groupings could become ACOs.

Patslatt1

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Accountable Care Organisation (ACO) model provides quality health care at moderate costs. Ireland's regional hospital groupings could become ACOs.

See https://innovation.cms.gov/initiatives/aco/ Experience in the USA shows that the ACO model keeps effective controls on unnecessary tests and procedures done for business and defensive legal reasons while providing quality health care. The HSE's plans for regional hospital groups seems a step towards the ACO model. But is this reform proceeding rapidly enough? Primary Care group practices were announced with great fanfare about a decade ago but there are few of them in operation.
 
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Nemesiscorporation

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See https://innovation.cms.gov/initiatives/aco/ Experience in the USA shows that the ACO model keeps effective controls on unnecessary tests and procedures done for business and legal reasons while providing quality health care. The HSE's plans for regional hospital groups seems a step towards the ACO model. But is this reform proceeding rapidly enough? Primary Care group practices were announced with great fanfare about a decade ago but there are few of them in operation.
You clearly have never seen high quality care or understand what moderate cost is.
 

Schuhart

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See https://innovation.cms.gov/initiatives/aco/ Experience in the USA shows that the ACO model keeps effective controls on unnecessary tests and procedures done for business and legal reasons while providing quality health care. The HSE's plans for regional hospital groups seems a step towards the ACO model. But is this reform proceeding rapidly enough? Primary Care group practices were announced with great fanfare about a decade ago but there are few of them in operation.
Just a sanity check.

The USA spends far more on healthcare than any other country. So a system that saves money compared to what they usually do might be utterly barmy in our context, and far more expensive than what we currently do.

According to the OECD, USA spent $9,900 per head on healthcare in 2016.

Ireland spent €5,500 per head, the sixth most generous level of funding. So we clearly have a problem compared to most other countries, particularly as our population is so young. Anyone who says we need to spend more on health is either a knave or a fool.

But you'd want to be clear that whatever the US is doing to reduces its ludicrous spend is actually less expensive than what we have already.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
 

Patslatt1

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Just a sanity check.

The USA spends far more on healthcare than any other country. So a system that saves money compared to what they usually do might be utterly barmy in our context, and far more expensive than what we currently do.

According to the OECD, USA spent $9,900 per head on healthcare in 2016.

Ireland spent €5,500 per head, the sixth most generous level of funding. So we clearly have a problem compared to most other countries, particularly as our population is so young. Anyone who says we need to spend more on health is either a knave or a fool.

But you'd want to be clear that whatever the US is doing to reduces its ludicrous spend is actually less expensive than what we have already.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
The US wage costs in medical care are generally higher, contributing to the higher US costs.

The higher US costs don't mean there are no lessons to be learned from ACOs. It wouldn't take long to analyse the basics of ACOs to see if they are compatible with proposals for Irish regional hospital groups.
 

Notachipanoaktree

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See https://innovation.cms.gov/initiatives/aco/ Experience in the USA shows that the ACO model keeps effective controls on unnecessary tests and procedures done for business and defensive legal reasons while providing quality health care. The HSE's plans for regional hospital groups seems a step towards the ACO model. But is this reform proceeding rapidly enough? Primary Care group practices were announced with great fanfare about a decade ago but there are few of them in operation.
Sh*ite......Gimmie the money.......Gimmie the money.

Off with their heads.
 

ruman

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Just a sanity check.

The USA spends far more on healthcare than any other country. So a system that saves money compared to what they usually do might be utterly barmy in our context, and far more expensive than what we currently do.

According to the OECD, USA spent $9,900 per head on healthcare in 2016.

Ireland spent €5,500 per head, the sixth most generous level of funding. So we clearly have a problem compared to most other countries, particularly as our population is so young. Anyone who says we need to spend more on health is either a knave or a fool.

But you'd want to be clear that whatever the US is doing to reduces its ludicrous spend is actually less expensive than what we have already.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Anyone saying we need to spend money usually works in the Health Service. The former Director General of the HSE was looking for an extra €9 billion a while back.
Unfortunately more spending on health in Ireland just leads to higher salaries for staff with no improvement in services for end users.
You would have to wonder what other large organisations could state "my customers need to give me more money" yet O'Brien is allowed to peddle this rubbish without being questioned.
Our spending is already more then sufficient, sadly gross incompetence and a complete lack of leadership means much of it is wasted.
 

Dame_Enda

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Just a sanity check.

The USA spends far more on healthcare than any other country. So a system that saves money compared to what they usually do might be utterly barmy in our context, and far more expensive than what we currently do.

According to the OECD, USA spent $9,900 per head on healthcare in 2016.

Ireland spent €5,500 per head, the sixth most generous level of funding. So we clearly have a problem compared to most other countries, particularly as our population is so young. Anyone who says we need to spend more on health is either a knave or a fool.

But you'd want to be clear that whatever the US is doing to reduces its ludicrous spend is actually less expensive than what we have already.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Yes but doctors/nurses wages are higher in the US than in Ireland so of course it will cost more.

The jury is out on ACOs.

......Pioneer savings
On July 7, 2013 the Centers for Medicare and Medicaid Services announced the results of the Pioneer ACO demonstration. According to them, costs for more than 669,000 beneficiaries served by Pioneer ACOs grew by 0.3 percent in 2012. Costs for others grew by 0.8 percent in the same period. CMS stated that 19 out of 32 pioneer ACOs shared savings with CMS. The Pioneer ACOs earned an estimated $76 million. Two Pioneer ACOs generated losses totaling an estimated $4 million. According to CMS the savings were due, in part, to reduction in hospital admissions and readmissions.[13]...
On the other hand it seems to have worked better in NY:

.......New York State ACO Model
Public Health Law (PHL) Article 29-E requires the Department of Health (Department) to establish a program governing the approval of Accountable Care Organizations. PHL § 2999-p defines an Accountable Care Organization (ACO) as "an organization of clinically integrated health care providers that work together to provide, manage, and coordinate health care (including primary care) for a defined population; with a mechanism for shared governance; the ability to negotiate, receive, and distribute payments; and accountability for the quality, cost, and delivery of health care to the ACO's patients" and that has been issued a certificate of authority by the Department. The Greater Buffalo United Accountable Care Organization was the 1st Medicaid and Commercial ACO in New York State. It received 1 of 10 NCQA ACO recognitions in the country. The model of integrated health care and high level results displayed by Greater Buffalo United Accountable Care Organization (GBUACO) have been set as the building ground for other ACOs in the state...
Personally I think the health service needs to bulk buy more to get discounts on drugs and equipment, and get rid of the cosy cartels exposed in the Prime Time Investigates program a few yrs ago.

I would point out that one reason for the extortionate price of pharmaceutical drugs in the US is that Medicare is banned from negotiating with the drug companies. But in Ireland, politicians are terrified of offending Big Pharma because they export €61.7 billion of pharmaceuticals from Ireland in 2017, which is around one third of the entire economy. We are 6th in the world for pharmaceutical exports.

On the hospital-group thing, I dont think Leo and Simons original plans as health ministers are likely to go through given the governments precarious 'majority' based on a hodge-podge of FG, Independents and FF. I think Harris's plan before the 2016 election was to allow for failing hospitals to be handed over to the private sector, and for there to be hospital trusts that could set different pay and conditions for hospital staff.

On a positive note ACOs do allow for performance related pay, which I have always supported, and which have the advantage of increasing throughput of patients to best medical practice.
 
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Schuhart

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The US wage costs in medical care are generally higher, contributing to the higher US costs..
That doesn't explain it. The OECD figures adjust for local cost factors.

US is ridiculously costly, on a purchasing power parity basis.

They should be hiring Tony O'Brien to show them how to introduce spending controls. They should be headhunting the HSE top brass.

That's how bad they are.
 

Patslatt1

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Anyone saying we need to spend money usually works in the Health Service. The former Director General of the HSE was looking for an extra €9 billion a while back.
Unfortunately more spending on health in Ireland just leads to higher salaries for staff with no improvement in services for end users.
You would have to wonder what other large organisations could state "my customers need to give me more money" yet O'Brien is allowed to peddle this rubbish without being questioned.
Our spending is already more then sufficient, sadly gross incompetence and a complete lack of leadership means much of it is wasted.
Plus an unnecessarily large number of expensive acute care hospitals, about 30 or 40 depending on definition,when maybe a dozen would do. This large number is the historical legacy of The Irish Hospital Sweepstakes lottery which was a popular form of illegal gambling in the USA. There is a joking phrase circulating, "That's as dangerous as a small Irish hospital". Lack of volume tends to prevent doctors from getting sufficient practice in their specialties in small hospitals.
 

Patslatt1

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That doesn't explain it. The OECD figures adjust for local cost factors.

US is ridiculously costly, on a purchasing power parity basis.

They should be hiring Tony O'Brien to show them how to introduce spending controls. They should be headhunting the HSE top brass.

That's how bad they are.
Gold plated health insurance for upper income groups, lack of antitrust enforcement against regional hospital monopolies,massive medical litigation and excessive care that prevent natural deaths have been driving up US medical costs.

Obama tackled the first by taxing gold plated policies.

Antitrust law doesn't apply to medical care, presumably to allow centres of excellence to focus on extremely expensive high tech care and achieve monopolistic economies of scale.

Medical litigation is likely excessive in the US but Ireland isn't immune going by insurance for obstetrics that has been about the world's highest for a generation.

Most medical costs occur in about the last six months of a person's life. In the US, motivated by insurance money hospitals are apparently too aggressive in keeping people alive instead of letting them die a natural death when further medical intensive care is pointless. Adult children of the dying can also be to blame for this.
 

Patslatt1

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Yes but doctors/nurses wages are higher in the US than in Ireland so of course it will cost more.

The jury is out on ACOs.



On the other hand it seems to have worked better in NY:



Personally I think the health service needs to bulk buy more to get discounts on drugs and equipment, and get rid of the cosy cartels exposed in the Prime Time Investigates program a few yrs ago.

I would point out that one reason for the extortionate price of pharmaceutical drugs in the US is that Medicare is banned from negotiating with the drug companies. But in Ireland, politicians are terrified of offending Big Pharma because they export €61.7 billion of pharmaceuticals from Ireland in 2017, which is around one third of the entire economy. We are 6th in the world for pharmaceutical exports.

On the hospital-group thing, I dont think Leo and Simons original plans as health ministers are likely to go through given the governments precarious 'majority' based on a hodge-podge of FG, Independents and FF. I think Harris's plan before the 2016 election was to allow for failing hospitals to be handed over to the private sector, and for there to be hospital trusts that could set different pay and conditions for hospital staff.

On a positive note ACOs do allow for performance related pay, which I have always supported, and which have the advantage of increasing throughput of patients to best medical practice.
ACO savings on hospital admissions and readmissions look like progress although there may be some corner cutting. There are great differences across the US in hospital admissions,with high admissions areas achieving no discernible effect on health outcomes. For instance, a heart stent operation may be no better than courses of the new generation of heart drugs. Also, a recent study in Sweden showed that professional collaboration among specialists there reduced surgical mistakes to a small amount, whereas about a fifth of US operations have mistakes that need hospital readmissions. Maybe ACOs are encouraging Swedish style collaboration among former Joe Loner specialists.
 

Lumpy Talbot

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A question I've had in my mind for some time and which quietly seems to be placed beyond proper governance is the system of the HSE paying out compensation on the grounds of failure and negligence and usually tied to non-disclosure agreements.

I think there is something of an elephant in the room here down the years and if you are talking about the public costs associated with the health service, the HSE and ultimately hitting the taxpayers' pocket then there are too few questions being asked in the Oireachtas of the relevant Ministry in terms of stats on this cost.

I suspect it is far higher on a routine basis than most people would believe.
 

Schuhart

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A question I've had in my mind for some time and which quietly seems to be placed beyond proper governance is the system of the HSE paying out compensation on the grounds of failure and negligence and usually tied to non-disclosure agreements.

I think there is something of an elephant in the room here down the years and if you are talking about the public costs associated with the health service, the HSE and ultimately hitting the taxpayers' pocket then there are too few questions being asked in the Oireachtas of the relevant Ministry in terms of stats on this cost.

I suspect it is far higher on a routine basis than most people would believe.
I'd agree to an extent; there's a lot of confusion around clinical indemnity costs, and folk don't seem to know that the State pays out these claims directly.

Attached material might be of interest to you.

http://www.politics.ie/forum/health-social-affairs/264615-alan-kelly-wants-legislation-allow-compo-claims-stillborns-6.html#post12167725
 

ruman

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A question I've had in my mind for some time and which quietly seems to be placed beyond proper governance is the system of the HSE paying out compensation on the grounds of failure and negligence and usually tied to non-disclosure agreements.

I think there is something of an elephant in the room here down the years and if you are talking about the public costs associated with the health service, the HSE and ultimately hitting the taxpayers' pocket then there are too few questions being asked in the Oireachtas of the relevant Ministry in terms of stats on this cost.

I suspect it is far higher on a routine basis than most people would believe.
Also that the HSE complaints against doctors to the medical council are effectively non existent. So the taxpayer pays and those reponsible face no action.
 

Patslatt1

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Also that the HSE complaints against doctors to the medical council are effectively non existent. So the taxpayer pays and those reponsible face no action.
Ireland is the land of the bureaucratic cover up!
 


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