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Skepticism Regarding ACO's Print E-mail
Written by Name Withheld   
Thursday, 27 January 2011 16:26


Regarding ACO's A Viable Concept? By Michael Casanova Click here to view original article

As a practicing physician, I see ACOs as just another administrative layer that siphons off funds that could be used to pay for healthcare. Since hospitals and hospital systems are infinitely better financed and unified, physicians will unfortunately probably become the junior partner, meaning more profits for hospitals and smaller profits for physicians.  Politics within the medical community may also play a part. For example, a surgeon may take much more time to perform various procedures than others of his specialty and he may even have more complications all of which increase costs, but he is chief of staff, chief of surgery, or even a share holder in the ownership of a hospital. It would be difficult to remove him from an ACO.  Likewise, a particular surgeon may have all the most difficult high risk cases referred to him, so that his complication rate seems higher. As he runs the risk of being dropped by an ACO because his costs for care are higher, he may choose to refuse these difficult cases, though he may be the most qualified in the community to accept them.

In South Florida, we had a system called capitation, in which the primary care physician got a fixed payment each month based on how many of that HMO's patients were assigned to him and he had to pay for those patients.  If none or few of the patients needed care, he made a lot of money.  If many patients needed care, and in particular surgery, he didn't make any or very little.  By slowing down the process, delaying or denying consultations with specialists, scheduling tests or procedures, and other gimmicks, he could insure a better profit at the expense of his patient population.  This could and did happen.

There are so many other ways in which Medicare could save huge sums of money that ACOs aren't really necessary.  What is necessary is for politicians to take appropriate steps and stop protecting powerful groups like trial attorneys and insurance companies.  I have a number of ideas that I think would work.

-Name Withheld by Request

Last Updated on Wednesday, 30 March 2011 16:06

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