Citing massive budget and staff cuts, federal officials are set to scale back or drop a host of investigations into Medicare and Medicaid fraud and abuse even though cracking down on government waste and cutting health care costs have been top priorities for the Obama administration.
It turns out, the Center said, the
Office of the Inspector General for the Department of Health and Human Services
will lose some 400 employees--auditors, investigators, evaluators--who kept an
eye out for Medicare and Medicaid fraud. The agency blamed "expiring funding
streams," and the sequester didn't help.
Accountable Care Organizations.
Obamacare supporters eager to see lower medical costs as a result of the
Affordable Care Act are pinning some of their hopes on accountable care organizations or ACOs--groups of healthcare providers who come together to
provide coordinated care that eliminates duplication and theoretically poor
care. Obamacare financially encourages them. A year and half ago, the
government selected 32 ACOs as pioneers to test the theory that by giving
patients better care, the costs would come down. A piece by Kaiser
Health News in mid-July tells us that the results so far are mixed at best.
The so-called pioneers managed a gross savings of about $87 million, but only 13 saved enough money to share the savings with Medicare, which was the point of the exercise. Two plans actually owed Medicare money. Nine plans are leaving the three-year program before it ends; most are joining other arrangements that carry less risk. Medicare head Marilyn Tavenner said that "successful Pioneer ACOs have reduced costs for Medicare and improved quality of care for their patients." But Chas Roades, chief research officer at the Advisory Board Company , a health technology and research consulting firm, said, "Going forward, I think we should temper our expectations about how much money we're actually going to save through ACOs."
Looking ahead.
The next stage of Obamacare is the one that we should watch most carefully,
as exchanges set up by the law start selling insurance policies to the
unininsured and granting subsidies help people pay for them--the heart of the
Affordable Care Act. If people get better insurance for the buck, and decide
they can afford the coverage rather than pay the tax penalty, and sign up in
droves--that's a huge hit. But it's a complicated machine to start up and
operate, and reporters need to watch closely. There are bound to be misses and
mixed results. Whether they will undermine the success of the law is a big
unknown. Neither the Democrats, the Republicans, or the press has a crystal
ball.
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