Usually when I sit down to write a blog post, my fingers fly across the keyboard as they madly try to keep up with the thoughts coming fast and furious.
With the topic of ACOs, it is quite the opposite. My fingers are poised waiting for a thought, any thought to flit across my brain. I don’t know much about ACOs and in that position it sounds like I have plenty of company. The language around ACOs seems purposely vague — either to allow the idea to develop into the best possible outcome or because it is a poorly-defined idea that is not well understood.
How will ACOs impact me? Quite a lot and not much at all, I suspect. Here’s how. ACOs ultimately impact how I am reimbursed, which matters a great deal for all kinds of reasons, not the least of which is that I am the primary breadwinner in my family. A lot of things impact how much I am paid though and this seems to be ever changing and highly variable as health care reimbursement is continually being debated, tweaked, and overhauled. I wholeheartedly agree with some of the basic concepts behind ACOs while still being left scratching my head wondering why we need to create yet another acronym-rich, detail-poor way of describing what it means to provide good, quality care.
Does anyone in America think it is a good idea to not have physicians speak with each other about common patients? Is it difficult for anyone to figure out why, if you get paid to make widgets, you’ll make more widgets so you can make more money? Is there anyone left who doesn’t advocate better quality for lower cost?
So, many of the presumed goals of ACOs seem like no-brainers. I do think there are historically neglected areas that ACOs highlight such as modifying fee-for-service payment, looking at both patient-specific and population based health outcomes, and encouraging physician communication and co-management. Whether ACOs are the tool by which our health care system lumbers forward remains to be seen.
This is what I care about at the end of the day:
1) I have the tools needed (material and human resources included) to do my job well which ultimately means providing exceptional, compassionate patient care.
2) I am not beating my head against the wall because Medicaid will pay for my patient to be on a super-expensive new medication for diabetes but will not pay for Tylenol that he needs to treat the osteoarthritis in his knees which is preventing him from engaging in the best no-cost exercise available to him — walking.
3) My role as a primary-care physician is respected by patients, insurers, the government, and fellow physicians while simultaneously the system is not requiring that all healthcare efforts for the least insured and most complex patients rest solely on me.
4) That someone, somewhere with the power to act will develop some common sense about how health care is priced, billed, and reimbursed.
If ACOs are able to accomplish any of these goals or even move us a few steps forward along the path, then they will be a great development, to my way of thinking. If not, they are just one more complicated way of the government not doing what they have been tasked to do.
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