Category: Alternative Payment Organizations

Enterprise Gone Overboard


My satellite clinic is about an hour away. I drive there with my nursing staff each month.

We load up ECG equipment, pacemaker programming machines, and a few other doctoring items in my truck.

I provide services to an area that has no permanent resident doing what I do.

Then, I return home.

Today is one of those days. I arrive back to my main office. It’s after 5pm and officially closed for the evening. I hurry to help my remaining staff return numerous phone calls to patients who had left messages while I was away. I hope to finish up at the office soon. Then, I intend to check on a patient at the hospital before making it home for dinner with my family.

I peer down at a piece of paper on my desk, given to me by one of my staff. It’s a printed email message. Sent by the Centers for Medicare and Medicaid Services (CMS).

The message is arguably from the most descriptive email address on the planet—and I’m not making this up—it’s from DONOTREPLY@CMS.GOV.


It’s rather fitting.

Because they definitely don’t want you to reply. That would be easy for me. Too efficient, perhaps. No, they don’t want a reply. They just want me to DO what they say.

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Accountable Care & Its Productivity Complex


It is absolutely absurd to reward someone for being less productive.

This entire principle is befuddling to me.

But, a government think tank has decided this is the future of American medicine. “We’ve discovered a better way to muddle with the healthcare market,” they say.

The previous (and also ridiculous) system, built upon an UNKNOWN fee-for-every-service, is now being replaced by a more accountable one.

Accountability, like safety, is an easy concept on which to build support. Why? Because we need accountability in healthcare.

If the term, Accountable Care Organization (ACO), is not commonplace for you yet, it will be. In fact, you may already be receiving your medical care from one right now.

ACOs are networks of doctors, hospitals, and other medical providers that share responsibility in the care and cost of a large population’s health.

Think of them as being the It.

And, It may be caring for you.

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America’s Epidemic of “Less is More” in Medicine


Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for The New Yorker. His most recent article discussing unnecessary healthcare is, as expected, a good read.

I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost healthcare. There just remains disagreement on what our biggest obstacles are, and how they should be overcome.

I agree with Dr. Gawande on some things, but after reading his most recent opinion piece, I must caution you about several medical inaccuracies found within it.

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The Journey Toward No Medicine At All


You gotta hand it to our Health Department. They are laser focused on this one. They want 85% of payments made to doctors by the Centers for Medicare and Medicaid Services (CMS) to be linked to clinical quality measures within the next two years.

Moreover, I suspect the Health Department is still giddy from Congress passing a new healthcare bill earlier this month. The legislation implements a number of controversial things for a nation built on the premise of freedom, but one of these is to push medical providers into unproven “alternative payment organizations” in order to move away from what has become known as fee-for-service.

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