Accountable Care Organizations (ACO's), Panacea or Myth

Posted by Stephen Weinberg, MD FACC FACP
Accountable Care Organizations (ACO's) are being formed at the behest of the government as a means of saving money and improving quality of care. ACO's are organizations centered around large entities such as hospital systems, insurance companies, large regional physician organizations. In essence, the organizations will ultimately receive an annual lump sum payment from the government/Medicare or private insurance companies to manage the entire medical needs of a large group of patients. This will include office visits, hospital care, testing, rehab, drugs, physician payments, etc. The organization will either contract with, own or employ the physicians, hospitals, home care, rehab centers, etc. and try to obtain the best pricing possible. In many instances, the physicians will be at financial risk on an annual basis. If the ACO makes money, the physician will receive a bonus and if it loses money, they will be subjected to decreased income. Quality measures will also be analysed, but the preponderance of weight will be related to profit and loss. Therefore, the physician will be incentivized to reduce costs through decreased testing, procedures, drugs, hospital days, rehab and everything that has a cost associated with it. Does this sound familiar? It was called HMO's, but now has a new name. ACO's are HMO's on steroids. The physician will be much more incentivized to withhold care since he will potentially have a decrease in salary if the ACO loses money or does not make enough money to meet the financial expectations of the organization. Profit incentives of private insurers added to incentives of the ACO"s will drive down the amount of money spent on healthcare. Washington is pushing hard to make this a reality by using financial payments and penalties to achieve 75% conversion (from fee for service to risk structures) in the next several years.
RATIONING of care is coming as a result.
Do we really want physicians making critical decisions regarding our health with such financial pressure? How do we know they will always have our best interests at heart? Do you really want to be in a situation where you are second-guessing  every decision your physician makes? I am certainly in favor of appropriate expenditures based upon clinical guidelines and limiting of inappropriate expenditures recognizing that not everything is always black and white, thus requiring medical judgement.
I thought the HMO issue was resolved with the overwhelming opinion that this type of healthcare delivery was not acceptable. Do we really want to go back?
This plan is worse!