Tag Archives: ACO

How to pay the Doctor?

25 Apr

Since the most remote times people have asked themselves this very stressing question: how can we pay the Doctor (or the Shaman if the times were even more ancient).


Hospital (Photo credit: José Goulão)


Hospital (Photo credit: José Goulão)

Most part of the time, in the countryside, where money was rare, the practitioner or care provider or whatever name you give him, was paid with a chicken or a basket of vegetable.

But when the prices went higher and higher, especially when Doctors needed the environment of a hospital facility to be more efficient, to give the all farm or the entire herd of cow would not have been enough. So hospitals then after them Doctors themselves decided to give incentives to the population to be more foreseeing by creating mutual funds aiming to finance their potential needs of care.

But for those funds the question still remained the same: how to pay the Doctor (or the hospital, or the nurse etc…).

The first step was to pay for the time spent, the number of Doctor’s visits needed or the devices that were used. But the more the patient stayed at hospital or the more the Doctors used devices or made visits the more they were paid. Then the funds decided not to pay for the service in itself (fee for service) but instead for the seriousness of the pathology which needed to be cured (diagnosis related groups). But here also the insurance funds saw a potential problem: what if the Doctors or the hospital, once paid for the so called pathology did not enough to cure it (eg not enough visit, cuts in the devices really needed, shortening too much the length of stay at the hospital and so on)? Consequently to this suspicion of drift came one more step to the answer to the question “how to pay the Doctors (or the hospital)”: the funds will pay only if the Doctors are well-organized (Health maintenance organization or HMO with gate-keeper, disease manager and plenty of complicated procedures to be followed by the specialists as well as the primary care practitioner). But the HMO didn’t keep their promises and the cost of paying the Doctor kept on its escalade at an even faster pace. Then after came the ultimate step of the chain of solutions imagined to pay the Doctor without starving once the debt is paid: the financial reward of the Doctor should be proportional to the quality of the care (pay for performance): the question is not only what has been done, not only for which disease, but also was it efficient?
In the meantime the accountable care organisations (ACO) of the Affordable Care Act was voted under the Obama administration which intend to bundle the finance of the health care without making a difference between ambulatory daily cares and in patients treatment. But in my view I doubt that the ACO will perform better than the HMO did given their similarity.

More content:
Healthcare reimbursement will change dramatically in the future


Looking for Solutions in a Rapidly Changing Health Care Environment



I’ll be back…

31 Jul

Everybody remember this legendary reply in the movie « Terminator”.

But what if the reply stands in the mouth of a Medicare enrolee being just discharged from a hospital stay?

These words are really frightening the federal administration.

According to a study published by the New England Journal of Medicine, 20 percent of patients could have pronounced leaving the hospital the same three scaring words as Schwartzy pronounced when leaving the police station.

With the new ACO (Accountable Care Organisations) hospitals could be held reliable from what happens to their patient after their discharge. In this model of health management some hospitals will employ primary care practitioners or nurses to follow the discharged patient when returning at home. Medicare could pay a single fee per patient to cover all the cares which are undertaken in and outside the four wall of the hospital.

Meanwhile Medicare think to penalize hospitals that present high readmission rates within the 30 days following discharge.


9 Jul

In the USA after the HMO (Health Management Organisation) here comes the ACO (Accountable care Organisation). Physician don’t accept to be aligned with hospitals. What is the best : fee for service (physician) or fee for organisation (hospitals). Both have their advantages. In France instead of alignment with prefer private/public complementarity and hospital are financed with a mix of fee for service (PMSI) and fee for organisation (Global budget).

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