Friday, February 18, 2011 ACOs - Friend or Foe?

Preface:, a physician social networking website founded in 2006, , has 115,000 M.D. and D.O. “colleagues.” Credentialed but anonymous physicians post opinions, questions, early warning reports of adverse drug effects, and respond to surveys. Critics say Sermo’s contents are incomplete, anecdotal, and generated by angry, discontented doctors. Nevertheless, the Sermo website is worth reading. It reflects the temper of the times.

Within the last week, Sermo ran a piece on Accountable Care Organizations and asked for readers’ opinions. Hundreds responded, and the response was overwhelming negative. Here, to give you a feeling for what was being said, is the introduction to the piece and ten responses.


My name is Susanne Madden. and I’m CEO of the Verden Group, a consulting firm founded to advise and help physicians navigate through the increasingly complex business of healthcare. I am working with Sanofi-Aventis, U.S. (S-A) on their initiative, a commitment from S-A to provide physicians resources regarding the current business challenges in medicine.

I’d like to discuss with you the advent of Accountable Care Organizations or ACOs. Is this a model that will help or hinder physician practices? Will they prove to be a more efficient or effective way to manage patient care? Or is this a mechanism for larger organizations and hospitals to better manage the market.

Ten Responses

1. Family Medicine

ACOs will result in vertical integration and evisceration of urban practicing physicians, placing all of the decision making in the central authority, removing the patient / doctor relationship. Rural healthcare will not be able to vertically integrate and will be crushed under the regulative burden, being held to the same standards and outcomes measures of an ACO. It should take less than 5 years for ACOs to competely bastardize patient care and decimate health care for most Americans not living in a tertiary care environment.

2. Family Medicine

Hospital owned outpatient care is significantly more expensive than physician owned out patient care. (In my area I get about $60 for 99213 from CMS, the hospital owned clinic a mile away gets over $90 for the same service for the same patient). I see only one way how a hospital driven ACO is going to accept the reduction in payment that would be required to make them as cost effective as me - they are going to cut outpatient reimbursement to the bone, and they will absolutely be forced into using mid-levels for the bulk of their out of hospital follow up care.

3. Radiology

ACOs will simply add another layer of cost to the health care system. It's only purpose is to deny health care and take money out of doctor's pockets.
ACOs are based on the incorrect assumption that the hospital is the center of medical activity. Most medical care happens outside the hospital. Putting the hospital in charge of all healthcare is asking them to do something they have no knowledge or expertise in. Hospital administrator salaries will go through the roof, doctor salaries will drop.

4. Pathology

The creation of ACOs encourages hospitals to take over physician practices to continue to be the center of the payment world. However, they do not care about the doctors, they do not know how to manage their practices (nor do they care), and they do not care about the patients.

5. Internal Medicine.

ACOs, if implemented, will put clinicians fully at the financial mercy of either hospital or ACO administrative masters. Docs will have responsibility without authority, and ultimately it is the end of medicine's standing as a profession whose members exercise independent professional judgment.

6. Oncology - Hematology/Oncology

ACO is an example of the bureaucracies that we physicians do not want.

7. Family Medicine

Like other healthcare reform proposals, the ACO ignores the biggest cause of health care expenditures (IMO), patient behavior. All PCP's know what I'm talking about. No incentive seems to be present to encourage those "dirty words", PERSONAL RESPONSIBILITY, on the part of the patient population.

8. Anesthesiology

I am in favor of repealing the PPACA, and I am opposed to "gearing up for a place at the table."

9. Surgery - General

The entire ACO concept should be an anathema to any physician who understands the ethics of the physician-patient relationship. Couched in flowery language and the "promises" of physician "autonomy,” The ACO concept promotes the extension of covert rationing by the physician to the exam room or the bedside. The physician becomes a financial agent for the ACO, not a health care advocate for the individual patient. This extends the insidious erosion of the very core of medicine, the foundation upon which everything else is built, the trusting relationship between a patient and a physician.

10. Ophthalmology

An ACO is capitated care in a fancy tu-tu. The #1 problem with the concept, as previously mentioned, is that it contains no elements that will modify PATIENT behavior, eg utilization habits and demands for tests and medications. As far as ACOs in any way motivating patients to adopt healthy, low-medical-cost lifestyles, pardon me while I collapse in laughter.

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