More Detail on The Bad

I appear to have become fixated on Direct Contracting (DC).  I've been reading about it today, and want to preserve some links.  

Here are two vocabulary words for you, if you choose to read with me. 

capitation:  Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. 

MSSP:  Medicare Shared Savings Program.  This is part of the Accountable Care Organization (ACO).  It seems to return money to hospitals that save money.  I can't tell if it's good or bad.  It has been around for nine years.

So, what is Direct Contracting.  It's a new fangled ACO.  DC started in 2019 when Jared Kushner's old dorm-mate was appointed head of the Center for Medicare and Medicaid Innovation, also known as CMMI or the Innovation Center.  The dorm-mate (and former owner of a start up), Adam Boehler came up with the idea.  DC appears to be a way to shovel tax payer dollars to Wall Street.  There is a 10 point explainer here, which discusses the differences between ACO and DC.  This is a short read and worth your time.

What are the origins of DC, the ethical quagmire it presents, and why we are likely to be stuck with it.  The Intercept has written a bang up article on how it came to be, why it's unethical (shoveling tax dollars to Wall Street) and why it's the first step on the road to privatizing Medicare.

In May 2021, four Congress people sent a letter to Mr. Becerra (director of HHS) expressing their dismay over DC.  You can read that letter here.

Who is the lobbying arm for Direct Contracting, and what are they saying to Xavier Becerra.  See their letter here.

The Washington Post finally woke up and wrote about DC.  There is an informative op-ed here.  It's not a long read, and benefited from better editing that the last piece I put up. 

The fundamental question for which I still do not have an answer, is can I, the individual, opt out of this if I want to.   A person gets sucked in to it because their Primary Care Physician signed up to be in a Direct Contracting Entity.  They don't tell you they did it, you find out when you get an ambiguous letter from the government.  The letter from the lobbyists to Becerra suggests that the individual can opt out, but then again they are lobbyists and their job is lying.

It does not appear that President Biden is going to end this.  His deputy director of CMMI, Liz Fowler, is a supporter of Direct Contracting.  Several members of Congress are not.

Currently the thing is supposed to go into production in January.  So, there you go.  

Sunset last night.

Frost on the blow up snow man this morning.

In news of the good, Jim and I were both able to find new Levis we like today.  I have given up on women's jeans, too much spandex.  The mens' have much less.  The back pockets are a little big, but the fabric feels better.  New jeans for the win!