In a recent business article from the American Medical News they do a a pretty good job explaining the the dilemma doctors have on whether to join an Accountable Care Association. The goal of an ACO is to “allow fee-for-service payments with a bonus for lowering projected total costs while maintaining or improving quality”. As you know I get truly burned up with the indiscriminate use of the word quality. The term is overused and in my opinion, it is almost indefinable. Ask an administrator what quality is and he or she will whip out some numbers and give you the group LDL average of all your patients. Ask an experienced clinician and she will say it was when she sat and talked a patient out of killing himself or got a sick kid in right away and saved his life from meningitis. Immeasurable. But, back to story. The ACO “unicorn,” as it is described in the AMNews piece, is very perplexing to doctors and not many are sure about whether they want to be involved. Here is their summary of questions:
- How will practices will be judged and how will savings will be achieved?
- Will the ACO contract be only with Medicare or with commercial insurers as well?
- How will shared savings be divided among participants?
- How will reducing total cost of care received by a patient affect fee-for-service revenue?
- Will any loss be balanced out by shared savings bonuses?
I recommend you read the article and I get that this was placed in their “business” section but there is a glaring point missing from all this. Will this mythical ACO beast actually be better for the patient? They do not mention that ONCE in the article. Isn’t that important?