Originally Posted by
gauchojake
Bundled payments or episodic payments are when a provider or group of providers get a pool of money to care for a patient. This creates a team approach to healthcare and disincentives providers to over utilize. The ACA allows for a number of different "experiments" if you will for this model. Google ACO's, value based purchasing, p4p, or the coordinated care initiative...it's super exciting.
They can raise rates if their costs go up, but remember that they need to provide medical loss ratio rebates if they exceeded certain thresholds. It basically stops profit grab on the basis of "higher costs".
Number 3 is a lot more complicated that it seems, but we will get there at some point. There are a few big problems that exist. One is that there is no universal healthcare programming language. The systems can't talk to each other. There is HL7 but not every back office system is utilizing this language. Getting the info interfaced between pharmacy, nursing home, hospital, clinic, home health agency, and other providers is nearly impossible at this point. It is however a provision of the ACA so they will get it done. Being able to have the electronic medical record migrate across providers will be a key for cost transparency. The health plans also rely on HCPCS and CPT codes for goods and services that don't translate well to actual consumers of healthcare. They don't reflect the quality of care given, only a universal code to describe a procedure.
Eventually you will be able to see the quality of care given by provider, plan, and costs goods. We have a long way to go on this before we see a la carte pricing. The good news is that we have physician, home health, health plan, and nursing home rating systems that are pretty easily accessible so you can choose quality healthcare.
I don't disagree with you on the cost of the ER. The cost should be less, but there's very little evidence that ER's are a profit center for acute care providers. Most for profit entities have closed their ERs because they are a red figure on the balance sheet.
Also agree that most health plans/Medicare/Medicaid have paid ridiculous rates on products and procedures that they just didn't do a good job of pricing themselves. Take for instance Medi-Cal's rates on a standard wheelchair. For purchase it's over 600.00. Now you need someone to measure the patient and to deliver the chair and get some basic instructions so that they don't roll off the side of a cliff. If we're generous, let's say that costs a company 200.00 in overhead. That's one hundred percent profit at the cost to tax payers. That's fucking stupid. More good news - the ACA is forcing the plans to change their mindset and shop for better deals. Also competitive bidding is forcing Medicare rates down.
Eventually the ACA will do away with most fee for service models that encouraged this type of abuse. Is the ACA the best law ever for healthcare? Probably not. I have a fundamental disagreement with the government forcing anyone to do anything (ie individual mandate). The ideas behind the law otherwise are pretty well thought out and have a good amount of evidence to show reduction in healthcare costs.
I can't believe I just typed that. TL;DR