What Is The Accountable Care Organization?

[Abraham]

I received a letter from my family doc stating he was working with an ACO (oddly based in Missouri) and he would be sharing my personal health information with them - unless I opted out.

The letter went on to state that the Accountable Care Organization is a group of doctors, hospitals, and health care providers working together with Medicare to give me better service and care.

Uh-huh, but of course they don't state how this is to be accomplished...just trust them because that's enough information...I should just be a trusting geezer.

Am I suspicious?

Bet your bippy I am.

I opted out, but remain VERY curious as to the mechanics (if you will) of how they, the ACO, (which is of course part of Obamacare) would presumably be able to provide more service, etc.

Anyone here have an idea as to what the truth about these ACO's is really about?

P.S. I'll be seeing my doc in 2 weeks and will ask if he had a choice to be part of the ACO or if it was forced on him and why on earth would he be participating in an ACO in Missouri, when we're in Texas?

[WildBill]

I received a letter from my family doc stating he was working with an ACO (oddly based in Missouri) and he would be sharing my personal health information with them - unless I opted out.
Anyone here have an idea as to what the truth about these ACO's is really about?

I don't know about the truth, but this is an explanation written by a large HMO.

My quick take is that it is a risk pool that provides incentives and rewards to healthcare systems for providing less services to the patients.

http://www.kaiserhealthnews.org/stories ... n-faq.aspx" onclick="window.open(this.href);return false;

[mojo84]

Information sharing, use of electronic medical records, to help avoid duplication of tests and to also help measure outcomes. Doctors are receiving pressure to improve outcomes while reducing costs. The ACO is supposed to facilitate the achievement of those goals. In essence, your medical records and tests results will be available to all of your doctors within g the same aco network. For example, x-rays, mri's, blood test results etc will be available to all your docs including primary care doc, orthopedic surgeon, endocrinologist, cardiologist and proctologist. This way, they can all see your file without having to run their own tests. This is where they are headed with EMR. Also, so your I formation can be rolled up to the government agencies to help them make better decisions regarding healthcare policy.

It all sounds good in theory but I also think it is ripe for abuse if not managed correctly.

[mojo84]

Some pure speculation here. I suspect down the road, the aco networks will come into play to further limit which doctorsone can chose from. Not only will people be limited to their insurance carrier network but even further limited to doctors in their aco network. Once health insurance companies are eliminated, the aco network will be the one the patient is limited to. Therefore, if you want to see a particular specialist you may or may not get to.

[Abraham]

This is good information, please keep it coming.

With what I've read so far, I'm not reassured when I read that (distilled down) there are bonus's awarded for not providing...

mojo84 said:

"It all sounds good in theory but I also think it is ripe for abuse if not managed correctly."

And, HMO's sounded good in theory too, but the complaints about them were justifiably overwhelming.

Plus, when a governmental agency (most especially one part of Obamacare) assures me that this thing or that is good for me motivates me to run away far and fast!

[WildBill]

ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures.

My fear is that the ACO, rather than the doctor, will make the decision about what test and procedure is necessary.

[mojo84]

That's a valid fear.

[Abraham]

WildBill,

That particular bon mot was one I too immediately noticed and snorted with disbelief and no small amount of derision after I read it.

Oh yeah, they're looking out for what's medically best for us peasant patients, sure they are...lying snakes, no good, splutter, gag, cough, well, I'm sure you can guess the rest of my diatribe...

[WildBill]

WildBill,

That particular bon mot was one I too immediately noticed and snorted with disbelief and no small amount of derision after I read it.

Oh yeah, they're looking out for what's medically best for us peasant patients, sure they are...lying snakes, no good, splutter, gag, cough, well, I'm sure you can guess the rest of my diatribe...

I had a doctor who used to work for this HMO. He is the person who told me about the "risk pool". He left that employment [probably pushed out] and started his own private practice. During his short time at the HMO, he was constantly getting admonished by the administration and chastised by his fellow physicians for ordering too many tests, performing too many procedures and prescribing too many drugs. The more of the "risk pool" he spent, the smaller the bonus payments for the doctors.

[Abraham]

WildBill,

That's precisely the future I see in my Crystal Ball.

[chasfm11]

WildBill,

That's precisely the future I see in my Crystal Ball.

Unless something is done to change the balance of power in Washington, we are headed for a single payer system in healthcare. That's what my crystal ball says. The public sentiment to repeal the ACA will shrink not grow (in spite of what some pundits are saying) but the frustration with its effects will get worse and voila, the politicians will seize upon it and give us a UK like setup.

[Abraham]

And the UK is trying to shed their miserable socialized medical mess and go back to private care.

So, why can't we learn from them?

[scottmeador]

Run, hide and opt-out if you can. I work on a very large Electronic Health Record (EHR) system here in the DFW area. For an ACO your personal health records are sent via the internet to a regional Health Information Exchange (HIE) which stores it for retrieval by anyone[ with access. This includes the bureaucrats in at the Center Medicare and Medicaid Services (CMS) and their end of life navigators.

[gringo pistolero]

And the UK is trying to shed their miserable socialized medical mess and go back to private care.

So, why can't we learn from them?

Some people can learn from the mistakes of others. The rest have to urinate on the electric fence for themselves.

[rotor]

An ACO is more than just sharing electronic health records. Your doctor can do that now by signing up with an electronic portal and that is not a bad idea as immediate access to your medical records between physicians is not a bad idea. But an ACO is more, it is an Accountable Care Organiziation and the whole purpose is very similar to what used to be called an HMO. Physicians will be at risk for paying into the pot unless they save money for the ACO. So, if I get paid more to not grow corn than I don't grow corn. But in this case it is your health. Unless you are a physician, you won't know that you are not getting the best. I had cataract surgery and the opthalmologist who was a friend wanted to get me special lenses with extra UV protection because he knew I was a pilot. I had no idea that there was a difference. The hospital wanted me to get the low ball lenses. This is the governments way to ration again, penalize the doctor that doesn't go the cheap route and give him a carrot for "saving" money. Not that there isn't a lot of money that can be saved but don't save it on my health. Wall Street Journal reported the other day that NASA send their execs on one way flights to LA first class at over $14,000 a flight. Let them go coach like I do.