According to the
government website, Accountable Care Organizations (ACOs) are “groups of
doctors, hospitals, and other health care providers, who come together
voluntarily to give coordinated high quality care to their Medicare patients.”
This immediately begs the question, were patients not receiving high quality
care before, were doctors not coordinating with each other privately what was
in the best interest of their Medicare patients?
The real answer comes in
the next paragraph. “The goal of coordinated care is to ensure that patients,
especially the chronically ill, get the right care at the right time, while
avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in delivering high-quality care and spending health
care dollars more wisely, it will share
in the savings it achieves for the Medicare program.” (The boldfaced words
are on the website)
Let’s translate the
bureaucratic speak. The goal is not to prevent medical errors or give the
patient better care, patients already have the best medical care in the world; the
goal is to deny care, certain procedures, treatments, surgeries, and drugs to
the “chronically ill” and “spending health care dollars more wisely,” potentially
saying no to older or sicker patients because they’ve outlived their utility to
society. By doing so, the ACO will be rewarded with “sharing in the savings it
achieves for the Medicare program.” How do you think this “sharing” will be
decided?
The sooner the doctors
joined ACOs, the better. For example, the Pioneer ACO Model for early adopters
of “coordinated care” is no longer accepting applications.
The next tier up is the
Advance Payment ACO Model, a “supplementary incentive program for selected
participants in the Shared Savings Program.”
When I see the words
“incentive” and “shared savings” I immediately visualize financial reward for
the participating doctors who provide less care than the patient may need in
order to achieve Medicare savings. Why would Medicare need to save money?
Because over the next ten years, Medicare will lose $719 billion in order to
fund Obama Care.
At the top tier is the ACO
type which my mom’s doctor has joined with other physicians, the Medicare
Shared Savings Program, a program that helps a Medicare fee-for-service program
providers become an ACO.
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/
Suddenly my mom has become
a Medicare Fee-for-Service beneficiary and her primary medical care will come
from the participating doctors included in the ACO, and assigned by the Centers
for Medicare and Medicaid Services (CMS) of the federal government.
The ACO, according to this
letter, is neither a Health Maintenance Organization (HMO), nor managed care,
nor an insurance company. “The ACO is a new program developed by CMS for
Medicare Fee-for-Service beneficiaries with Original Medicare. Unlike HMOs,
managed care, or some insurance plans, an ACO can’t tell you which health care
providers to see and can’t change your Medicare benefits. You always have the
right to choose any doctor or hospital who accepts Medicare at any time.” What
is the problem then, why did you have to change your Original Medicare plan?
The answer is that
although you “have the right to choose any doctor or hospital who accepts
Medicare at any time,” there is no guarantee that your treatment will be
approved and paid for, and that your chosen doctor or hospital will accept you,
will accept Medicare of any kind, or worse yet, the chosen doctor or hospital
will still be in business.
Why would my mom’s doctor
need her to complete a Personal Health Assessment (PHO)? His office already has
complete medical records and her history. The ACO and the federal government
with whom it shares the data wants to have a complete and accurate picture of
mom’s health and needs in their data base in order to more efficiently ration
her needed care.
Even though patients have
declined to have Medicare share their personal health information with the ACO,
they still received this letter in the mail, telling them that “your doctor
will continue to work with doctors, hospitals and other health professionals to
provide more coordinated health care for you.” In other words, no matter what
you say or do, your doctor will still share all your health history with the
federal government on the national database.
Don’t worry too much, the
Personal Health Assessment (PHA) will be shared as needed with your Primary
Care Physician (PCP) and if he/she deems it necessary, he/she may share it with
other specialists or providers. But, your privacy is so important to them that
they have safeguards in place to make sure that your medical information is
safe and confidential.
I am sure hackers and con
artists salivating for your personal information are already laughing
themselves silly all the way to the bank. I forgot to mention that your
healthcare information will be required to have your bank account information.
To prepare patients for
end of life counseling which is mandatory in Obama Care every few years, the PHA question number six asks if, over the
last two weeks, you had “little interest or pleasure in doing things, and have
you felt down, depressed or hopeless?”
Will ACO give you improved
medical care? Yes, if you believe in Santa Claus. They say, as long as we can
share your information with everyone, they will know everything about your
medical care, medications, drug use, smoking habits, sexual habits, and
everything else that may help them have a “more complete picture of your
overall health.” Will they have the time to assess all this information if 30
more million people will be added to the national patient load while the number
of doctors remains the same or less? I seriously doubt it. The ACO is more
about citizen control and herding into an “I know everything about you and
better behave as I say” government.
Look at the bright side, under
Obama Care, you may not be able to keep your doctor as the Democrats promised, but
you will definitely keep your nurse or nurse practitioner. On second thought,
they may be too busy as well to see you on demand; you may have to wait a few
weeks.
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