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  • Breaking Health Care Research: "Accountable Care" Unlikely

    Medicare continues to be a looming problem in the fiscal crisis. In an effort to lower the program’s cost and improve quality of care for the seniors it serves, Obamacare creates accountable care organizations (ACOs), which are supposed to encourage health care providers to band together and create savings through better coordinated care. In a new Heritage research paper, health policy expert John Hoff writes:

    The ACO scheme is a microcosm of the PPACA (Patient Protection and Affordable Care Act) and, like it, will not deliver on its rhetorical promises. In the process of failing, it will waste financial and human resources, detract from meaningful reform, and give the Administration one more tool to exert control over Americans’ health care choices.

    Hoff explains that the ACO scheme is a complex web of regulations, often internally inconsistent and confused, resulting in an odd structure. As one example, Hoff writes,

    Medicare beneficiaries may be surprised to learn that they do not join an ACO as members. Nor is the process voluntary. Strange as it may sound, the CMS ‘assigns’ beneficiaries to an ACO, whether they like it or not…Beneficiaries will not know if they have been assigned to an ACO, or if so, which one. There is no provision for informing beneficiaries that they have been assigned to an ACO.

    Writing for Heritage, Dr. Rita Numerof also argues that ACOs are unlikely to actually improve the quality of care or to lower costs, but are likely to benefit the largest health care organizations and enhance their market concentration:

    Congress, apparently unmindful of legislating an untested model in a field as complex as health care, included provisions in the PPACA to establish ‘accountable care organizations.’ … It is unlikely that an untested organizational structure will be the most effective way to create ‘accountability for care.’… the likely result will be a concentration of power not in the most efficient and highest quality health care organizations, but in the largest—simply because they control large segments of the market square.

    Small reforms to fix the ACO provisions of the new law will not succeed at providing better quality care or driving down medical costs, because the flaws are embedded in the law’s creation of ACOs. Make sure to check out Hoff’s paper in its entirety here.

    Posted in Obamacare [slideshow_deploy]

    4 Responses to Breaking Health Care Research: "Accountable Care" Unlikely

    1. guest says:

      I believe the local hospital where I live in Geneva NY is already an 'Accountable Care organization" … Finger Lakes Health or Geneva Hospital. They work under a very different view of medicine these days. When you become ill, and go into their hospital, you are not allowed to have your own private physician take care of you, but a "Hospitalist" who is paid by the hospital takes over. He knows nothing about you, and as I hear doesn't see you all that often. The private physicians are unhappy about this, but now I understand what is happening. The hospital is hiring "their own" physicians and paying them a flat salary. So If you go to one of them, you can be certain they are working for the hospital, not putting their patient first.

      I didn't know Obamacare was already taking over how our healthcare works, but it seems even in this small city of 14,000 you can't hide from it. It is devastating and I wonder every day why I moved back to New York State.

    2. gutty says:

      "Obamacare creates accountable care organizations"

      They actually existed before the ACA and the shared savings program is merely one of several different pilots, demonstrations and other programs included in the bill which hospitals are free to take advantage of or avoid like the plague. Most are avoiding ACOs based on the proposed regulations.

      "In the process of failing, it will waste financial and human resources, detract from meaningful reform, and give the Administration one more tool to exert control over Americans’ health care choices."

      I don't know about the last part regarding exert control, but the rest of it is entirely possible if not likely.

      "Beneficiaries will not know if they have been assigned to an ACO, or if so, which one. "

      Also true, but beneficiaries will be free to get care from outside of the ACO.

    3. Mary says:

      Oh yes…and the large healthcare organization I work for is deeply invested in bringing "meaningful use" to our electronic med recs…asking invasive questions of patients: "what is your race, ethnicity and language" with predefined definitions of these. Suposedly to "help" physicians identify trends in genetic health conditions, etc. Physicians are well trained in these things…why the mandated intrusion and who in the government collects this info?
      We are already preplanning extra testing for patients we "might" be able to identify for an additional diagnosis to add for treatment plans reimbursable by the government. Since we will take a sizable cut as a physician group, we are forced to find ways to add services whether the patients will benefit or not. More regulations are coming, we are told, which will add additinal work for physician offices and invasive inconvenience for patients.
      We have yet to see the worst.

    4. gutty says:

      "Since we will take a sizable cut as a physician group, we are forced to find ways to add services whether the patients will benefit or not."

      Congratulations on admitting to submitting a false claim! If you are looking to make up for lost revenue might I suggest plans other than committing fraud.

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