Smells Like Profit by Pat Conrad MD
It would be far more rewarding to write a review of a top-tier bourbon, say, Pappy Van Winkle, but no, we’ll have to discuss his snoozy ancestor, Rip. As in slept for the last 20-plus years. As in, “YOU IDIOTS, NONE OF THIS IS NEW!”
Sigh. Our cowed society having apparently slept through the marvels of the HMO-strewn 1990’s, we now have to hear stories about Accountable Care Organizations and how they deny care. Like the HMO’s of yore, ACO’s use capitation, “quality” metrics, group purchasing, and ration-, oops, denial-, sorry, cost-effective care management to provide savings, which are then doled out to participating doctors after the ACO removes a slice for shipping & handling. Stop me if you’ve heard this one before.
CMS.gov says the goal of ACO care coordination “is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.” Wink, wink, nudge, nudge, say no more.
Ambulance-chasing bastard West Palm Beach malpractice attorney Ted Babbitt said. “Doctors are being paid to deny care to patients who need it. That in my estimation is just horrible.” And leave it to the med-mal barracudas to provide compassionate estimations, on an hourly rate. Rat Babbitt, Esq. is representing the family of a deceased 96-year old woman who was allegedly denied admission to the hospital after breaking her hip, despite being unable to walk or use the bathroom. Enter the grieving family seeking justice. Enter the compassionate attorney seeking, uh, same. Enter a moronic local “journalist” splashing utterly lopsided accusations that the local ACO is making millions, implying that they are doing so by denying care to little old ladies with busted hips.
This non-fact scribe Andrea Marvin delivers this innocent, plaintive little bleat: “So, how are doctors getting rich by working less?” then pins it squarely on ACO’s.
She quotes Dr. Richard Weisberg, C.E.O. of the Palm Beach ACO: “We are keeping our patients healthier, and keeping them out of the hospitals, and the E.R. where the main costs are.”
His 160 doctor ACO claims to have saved Medicare about $300 million in just one year, receiving a $36 million attaboy in return that was – mostly – distributed among said docs. Weisberg assures us that no one is being denied care.
Where are the other facts in the story? Could the local affiliate get no discovery details? I don’t for a minute believe that EMS was not summoned, that the elderly female was not taken to an ER, and then admission was not recommended for a heretofore ambulatory patient. If I am wrong, I hope someone will correct me, but I have been unable to find any other details on this case thus far.
Really, I think everyone in this story is lying. I’m certain the family is looking for a nice cash prize from an entity that just got an extra $36 million. Son George Matsouka is now a “patient advocate”, whatever the hell that means, because it will sound really good in front of a jury.
Lawyer Babbitt says, “The patient has no idea they are being denied care. It is impossible for a patient to know that they need that care until they get sick.” Help yourself with that one.
The government cannot fund Medicare, and is using these gimmicks to act like it can. The ACO CEO made an extra bundle by meeting “quality” metrics and using capitation to encourage cost savings. That can only happen by saying “no” to someone. Whether or not you agree with that approach, don’t tell me that doesn’t involve denying someone something. The doctors participating in the ACO all have their snouts in the till, and an indefensible conflict of interests. They are engaging in the same rationalizations that let the last two generations of physicians propagate government medicine with clean consciences and comfortable retirement plans. The author is lying by writing another grossly one-sided, doctors-are-evil piece under a byline that implies she is a journalist.
None of this is new, and all of this is predictable.
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Would anyone hire a lawyer or accountant who got paid more for doing less work on your case?
From the Washington Post back in September:
“For years I’ve believed and taught my students that fee-for-service medicine was a wasteful, dysfunctional way to reimburse providers for health care. Maybe it still is. But I now think that the supposed antidote — value-based reimbursement, which includes bundled payment plans — makes little sense and is equally dysfunctional, at least from the patient’s perspective. It can create a massive conflict of interest within a system that is neither coordinated nor collaborative, and facilitate gaming among the different institutions that are still very much concerned with profit.”–Timothy Hoff is a professor of management, health-care systems and health policy at Northeastern University in Boston
This after describing the travails of his 90 year old mother caught up in a bundled payment scheme after repair of a hip fracture. Maybe if academics like this see the folly of hospitals making money to withhold care, there is hope for the future. By my calculations, it took about 10 years to cycle through this BS in the HMO era of the ’80’s, so we may be halfway through the delusion that forcing hospitals and doctors to act as insurers is desirable.
https://www.washingtonpost.com/national/health-science/when-his-elderly-mother-broke-her-hip-things-didnt-go-well/2017/09/15/e5339060-7317-11e7-9eac-d56bd5568db8_story.html?utm_term=.ad533294554e