It’s Just One Horse – Don’t Stop The Ride! by Pat Conrad MD

By CMS standards, when a policy of wading for hours in raw sewage leads to patients getting gangrenous legs, we don’t declare the sewage to be the problem.  We simply amputate the gangrenous legs, declare the patients healthy, and tout the savings of reduced infection rates from sewage because now fewer two-legged people are entering the sump.

That is more or less the tack taken by CMS in its latest reassessment of their entire Accountable Care Organization concept.  The ACO’s were supposed to save money by herding Medicare beneficiaries onto “quality and cost” reservations made up of participating physician groups and hospitals, which would theoretically save money the way HMO’s were supposed to have saved money.  The ACO structure allowed new participants to stay in a “risk-free, shared-savings-only payment model” for up to 6 years.

“CMS Administrator Seema Verma said in a call with reporters in which the new proposal was announced that a ‘shocking” 82%’ of ACOs take zero risk for patient care, which has led to increased Medicare spending.”  Shocker.  Did this clearly overpaid CMS bureaucrat miss the Recession of 2008, and its Freddie/Fannie Ground Zero?  If Uncle Sugar makes a lot of risk-free money available, then said money will be spent, consumed, gobbled up, and will be gone.  Of course ACO’s were going to cut any corner they could, and free money would only encourage them.

“‘But after 6 years, we believe the time has come to put accountability into the accountable care organizations.  We now have enough collective experience that no provider group, whether they are a current ACO or considering becoming a future ACO, has any excuse for not providing value to patients and taxpayers,’ Verma said.”

“CMS… guesstimates that 117 ACOs will drop out of the program.  By eliminating the ACOs that are losing money and by keeping the ones that are creating savings, the overhaul is expected to result in $2.24 billion in savings over 10 years.”  So if we lop off the infected limbs, the patients are healthier than ever.

Ever true to form, the apparatchiks managing a program can’t, won’t admit that the program is a bust, or that it was borne of a stupid concept.  Instead, they are scrambling with alternative payment options that use a risk-reward tradeoff.  Worse yet, CMS layers on some additional corruption:  “With increasing risk, ACOs are granted exemptions from federal laws that prohibit anticompetitive practices and from the so-called Stark laws that govern self-referrals.”

Why should ACO’s be granted any exemptions, simply because they dance to the government tune?  Do you mean to say, Ms. Verma, that anti-competitiveness is fine as long as it is federally approved?  Aren’t you really saying that government monopolies, at least in health care, are a goal?


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]