Monday, October 1, 2012

32. Consequences of ACOs

32.  Consequences of ACOs


Yesterday, we learned about the Accountable Care Organizations and how they will reward providers for NOT giving potentially needed testing and care.  Now let’s talk about some other consequences of these organizations.


The ACOs are intended to provide comprehensive services for patients all in one place.  Sounds good so far, but think about it:  are all of your doctors and therapists in one institution?  Maybe you have an orthopedic surgeon that you really like in one area of town, your cardiologist is somewhere else and your primary care doc is in another area.  Under the ACO plan, you would be apportioned to a single group of providers—a group that may or may not include doctors that you like.  In the law, the Secretary of Health and Human Services has the authority to even assign you to an ACO, regardless of your wishes.  Are you kidding me?? She also has the authority to change your Prescription Drug plan if she thinks it justified. What country are we living in again??


Right now, 50% of physicians are employed by large medical group organizations, like Kaiser, or they’ve sold their practices to a hospital.  50%.  Why have they made this choice?  Mostly because they are fed up with the government regulations and bureaucracy.  Many because they can’t make a living anymore due to high overhead costs and malpractice insurance.  Once these ACOs go into effect, a physician in private practice will find it even more difficult to stay in business:  see the ACOs will control patient referrals.  If a doc isn’t a member of an ACO, and forced to abide by their rules, they may not have a patient base large enough to support their practice.


And you can forget about the independent outpatient surgery and imaging centers—centers that provide excellent care at a fraction of the cost of a hospital.  It will be the end of private practice and competition.  This is not what our country was meant to be!  America was founded on the notion that each citizen has the right and opportunity to prosper by providing a product or service that could create wealth for the innovator.  If the product was not desired by the consumer, the business would fail.  In the ACO model, we won’t have a choice.  There will be no other alternatives.  Our ability to control our lives through our consumer decisions will be gone.  An almighty government bureaucracy will be making those decisions for us.  Is that what you want? 

(Note: This commentary is by Dr. Jill Vecchio.)

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