Delusional

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.