I guess anyone can paint a picture differently depending on their perspective.  Take, for example, a group of docs who wrote an editorial in the WSJ entitled The Real Promise of “Accountable Care”.  This unicorn of a concept looks differently to whomever sees it.   For those that hate capitalism and the concept of being paid for a service they render, they seem to love the idea of accountable care organizations.  Forget the fact that there is no proof that they work.   Here some highlights from the piece that caught my attention with my thoughts in the parenthesis:

  • Accountable care organizations at their heart are about aligning provider financial incentives with patient needs for better health and lower-cost care. Unlike traditional third-party, fee-for-service insurance, which pays more for doing more, the payment models underlying accountable care pay providers more for achieving better care at a lower cost. (In other words, somehow patients will change their behavior in this new model or docs get penalized).
  • Under the ACO payment model, the health-care providers aren’t eligible to keep the savings from lowering costs unless they achieve measurable quality improvements. (Quality indicators and P4P have never been proven.  In fact, just the opposite).
  •  The innovations include replacing office visits with in-home monitoring tools and smartphone applications, the use of “patient coaches” to help at-risk patients avoid complications and greater involvement of patients in managing their own care and making important decisions.  (Those pesky office visits do get in the way).
  • The early evidence from private and public ACOs suggests that real savings are possible. The right direction for health-care policy is to build on ACO successes through further steps to reward low-cost innovation, while steering support away from health-care providers who are unwilling to change. (What evidence?  Show me the Car Fax!)

As you know there is nothing I love more than Ivory Tower experts pontificating on what should happen in the trenches.  Thank goodness there is no end to their bloviating.  It always gives me fodder to blog about.

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]

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1 Response

  1. Lawrence Dultz, MD,FCCP says:

    My organization (multispecialty group, hospital and our competing group) just joined an ACO. Marvelous. When I entered practice in 1993 I couldn’t build a pulmonary practice in a suburb of Philadelphia because there was high HMO penetration in the area and no one got consults. Then as now, doctors were rewarded for giving less care. To my small mind, giving “providers” an incentive to do less is a perversion of the doctor(oops, sorry provider)-patient relationship. In a couple of years, the providers will have the skin in the game and we’ll be writing checks to the ACO due to our noncompliant patients. Progress indeed…

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