To Join or Not to Join an ACO



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:

  1. How will practices will be judged and how will savings will be achieved?
  2. Will the ACO contract be only with Medicare or with commercial insurers as well?
  3. How will shared savings be divided among participants?
  4. How will reducing total cost of care received by a patient affect fee-for-service revenue?
  5. 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?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “To Join or Not to Join an ACO

  1. December 7, 2011 at 3:17 pm

    I for one feel there needs to be more ovarian fortitude!! Who ever saw testes on women be a good thing? Hormone replacement so agood, but should be balanced. If we move into this paternalistic approach, we ar sure to be losing independence and balance. It’s just another way of forcing a government run ipa model down our throats, and I agree with many of the above comments. The big issue, is that most practitioners won’t be able to opt out even if they want to.

  2. DrMark
    December 7, 2011 at 9:33 am

    On my most optimistic days, I do think there is possibility that the ACO concept will benefit a small percentage of patients who at high risk (i.e. the 10% who take up 80% of the resources). This unfortunately presumes that the ACO is implemented appropriately and that the PRIMARY goal of those involved is the best care for the patient(s) and not the bottom line cost efficiency. I’m not holding my breath.

    The large organization that I recently moved to has just decided to be an early adopter, so we’ll see how that goes.

    Meanwhile, there is NOTHING in any of this that speaks to individual responsibility on the part of the patient and/or family. So for a good proportion of the above mentioned 10%, what actually will happen will be outside of our control. For many patients, (and we all know who they are) no amount of “care management” is going to stop them from continuing their self destructive behavior and ending up back in the hospital (costing the ACO precious $).

    IMHO, no wheeling and dealing and “cost management” between the government and healthcare providers (in the broadest sense of the term), is going to fix the broken healthcare system until and unless the politicians grow some testes and put some of the responsibility back in the hands of the individuals, where it belongs.

  3. December 7, 2011 at 8:43 am

    Great job, Doug! Blessings on your efforts, Doctor!

    • Doug Farrago
      December 7, 2011 at 10:07 am


Comments are closed.