"Really, I probably live in a world of 140 codes.” AAFP President Robert Wergin, M.D.…
Organized Weakness by Pat Conrad MD
Putting “ACO” into the search window yielded at least one (probable) pornographic reference, which is a likely harbinger of the very near future. Fast on the heals (sic) of the widespread customer satisfactions garnered by H.M.O.’s in the 1990’s, the Obama Care law bearing down on us seeks to replicate these successes. An Accountable Care Organization is a network of doctors and hospitals that will co-manage the health care for a minimum of 5,000 Medicare beneficiaries for at least three years. The idea is that the care for deserving seniors will be streamlined, redundant testing avoided, and savings shall accrue to the taxpayer, with compliant doctors getting a few incentive crumbs for being their obedience. Hilariously, patients and their attentive families need not remain “in the network”, with no fear of financial penalty. NPR reports Health & Human Services estimates that ACOs could save Medicare up to $960 million in the first three years: less than one percent of Medicare spending during that period.
Will this new cellblock for the “private” physician be sufficiently large? AMA president Peter Carmel. MD sure hopes so. In an exultant column in the latest American Medical News, Carmel cheers “the power of organized medicine”, assuring doctors that they had dodged a big bullet. To be sure Carmel has cheered the big government line: “From the outset, the AMA supported the concept of ACO’s” (italics added). A lot of ink has been spilled in 2011 over the “meaningful use” requirement for electronic medical records (EMR) by primary care physicians, and the threats to their dwindling livelihoods if they don’t get in line; Carmel is thrilled that for the moment, that provision is gone. For those within safe walls of an ACO, core measures that must be reported have been reduced in number, Stark self-referral waivers have been expanded, and the Justice Department will be less quick to cast a baleful anti-trust eye, all of which leaves the AMA prez giddy. One can imagine Dr. Carmel rubbing his manicured hands over the crackling Yule log of D.C. cordiality, happy to have his fingerprints on such a present from the AMA, which includes a “$170 million initiative from the Center for Medicare and Medicaid Innovation” for the small fry practices that want to play. Is it impolite to ask, if this is such a great business model, then why would practices need buy-in assistance? Carmel is happy that a “rolling application process will …result in greater physician participation.” Of course he is.
For all his cheerleading, Dr. Carmel again demonstrates not the power, but the weakness of organized medicine, and the desperation of private practitioners. The AMA is fighting at best a weak delaying action, and this system will likely affect, and even disrupt the majority of physician practices in the nation, and will certainly increase the federal government’s daily role in all aspects of health care. Politicians congratulate themselves by referring to a slowed rate of deficit growth as a “cut.” The AMA president now congratulates his flock on fighting to have less government intrusion than originally prescribed by Obama Care. But ACO’s are coming, and very soon. Participating physicians may now contend with a reduced number of core measures to report, but only until the next bureaucrat sees fit to add a few more. Once tied financially into this system, the individual docs or their corporate owners will see just a little more work as part of the cost of doing business, gleaning from a yet smaller profit margin. Carmel is proud that ACO’s will “share in the first dollar of cost savings”, and “that will limit financial risk to physician practices.” How can anyone believe this even with the wolves of deficit howling in the winter night? Physicians are presently under the perennial threat of a Medicare pay cut, and the clamor for pay-for-performance is growing among those not constrained to provide either. These little half-truths and veneer victories are strewn like bread crumbs over the snow, coaxing private practices into the barn, where they may be properly stalled. ACO’s will not deal with the unrestrained demand of Medicare, and will not provide any appreciable savings. They will however, give cover to Dr. Carmel and the AMA as they increase physician participation, which is to say, compliance. That is the true power of organized medicine.