29 January 2011

ACOs – The fork in the Road

Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.

I am not sure of the value being assigned to this, but since it is part of the new law and at present still on the books, we should understand as much of it as is possible. I mean patients need to understand. We are the people who may have the most to benefit, or lose, by the new structures being promoted.

Do be concerned, as there are some dangerous flaws in the proposed models. Most will never be transparent and will be buried in technical and legal documents which we as patients, will never see. Accountable Care Organizations (ACOs) may continue to exist, but the rules and regulations governing them have yet to be defined.

It is going to be interesting to see what the organizations are going to look like. Are they going to be centered around hospitals, or will they be physician controlled, or will they be combinations of these? This is the interesting part. From my reading, it represents a jigsaw puzzle and may have small benefits for patients. The large benefits all seem directed to the physicians and hospitals.

There will be the small benefits to patients by reducing the duplicity of tests we now undergo, better (hopefully) care because physicians and hospitals will necessarily need to communicate more openly about patient care. This could translate into less errors foisted on patients. The large concern I see, will be how to handle doctors mistakes and they will have more layers of protection and harder to be dismissed for practice mistakes.

I will not make further questions until the form of the ACOs is actually known, but you can see many of them. There will be several more blogs about these and other problems with ACOs and their formation. These will be done as I decipher this area and learn more.

For those interested read this from the New England Journal of Medicine.

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