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Arkansas looks at bundling Medicaid pay

Arkansas Medicaid Director Eugene Gessow is aiming to transform the state's Medicaid program, starting by re-evaluating the costs to physicians and hospitals of providing quality health care. Gessow wants to examine not just Medicaid spending but all health care spending in the state -- public and private -- to find a benchmark for Medicaid payment. He envisions paying teams of physicians and other health professionals based on patients' episodes of care and allowing doctors to keep any savings they might generate. These partnerships would be similar to the health system reform law's accountable care organizations but would not be defined as specifically as ACOs. "In order to have a patient-centered approach, you need a team approach," Gessow said. Arkansas Gov. Mike Beebe has directed Gessow to move Medicaid away from fee-for-service payment. The current system won't allow the state to improve quality and control costs as needed, he said. "We need to stop paying fees for the ...

Frequent ED users take toll on emergency physicians

About 60% of emergency physicians say they have less empathy for so-called frequent-flier patients who visit the ED more than 10 times a year. Nearly 80% told researchers they hold some bias against these patients, and 82% said caring for them contributes to their level of burnout, according to survey data presented at the Society for Academic Emergency Medicine's June annual meeting in Boston. "The emergency room is becoming their primary source of care, and it's not any ER's goal to be an outpatient care provider. That's not the model of what the ER is supposed to be," said Jennifer Peltzer-Jones, PsyD, who led the survey team. "If you look at burnout, there's that lack of a sense of personal accomplishment. The ER model is you fix the patient and you get them out. If the patient keeps coming back for whatever social reasons or constraints, you can easily understand how ER physicians would not feel like they're accomplishing anything." Nearly all the 418 emergency physicians ...

Outgoing AMA president urges doctors to move medicine forward

In a call to action to the nation's physicians, AMA President Cecil B. Wilson, MD, urged doctors to "move forward" and work for changes to improve the health care system. Speaking at the opening of the AMA House of Delegates in Chicago on June 18, Dr. Wilson said Congress needs to repeal the sustainable growth rate formula and replace it with a mechanism that pays for costs of care and enhances quality and care coordination. He also called on Congress to approve legislation that allows Medicare patients and their doctors to contract privately without penalty. Dr. Wilson said moving forward means correcting areas of the Patient Protection and Affordable Care Act, such as the Medicare Independent Payment Advisory Board, which "puts physicians in double jeopardy by adding yet another target to the currently discredited SGR." "Moving forward means bulldogging the regulatory process to assure that the provisions of the Affordable Care Act are implemented in ways that benefit physic ...