As mentioned before (Accountable care shouldn’t equal consolidation) a very likely outcome of the evolution toward Accountable Care Organizations is consolidation under hospital-centric health systems. Hospitals are the ones with sufficient capital, infrastructure and scale to position themselves for the new environment. When they assemble the rest of the pieces they will be in a formidable position. That may be good news for hospitals, but it’s not particularly encouraging for most physicians, patients, health plans or taxpayers. That’s because such ACOs are likely to be expensive, bureaucratic and powerful.
Medical societies recognize where things are headed and are trying to devise approaches that will preserve physician autonomy and independence. In this case their views are well-aligned with the public interest and I hope they prevail. The American Medical Association (AMA) has been most vocal on this topic. Here’s what AMA president Cecil B. Wilson MD has to say about it in Healthcare IT News:
“The physician-led ACO model injects competition into the market by eliminating the need for consolidation under a hospital system,” said Wilson. “Competition fosters innovation, which ultimately helps patients receive efficient high-quality care. Care coordination is vital, and physicians can work together with a healthcare team to keep patients healthy and out of the hospital while maintaining independent medical practices. CMS should adopt policies that facilitate physician-led ACOs and do not inadvertently bias participation in favor of large health systems and hospitals.”
“Our goal is to ensure that new models of care benefit patients, and for this to happen physicians must be able to successfully participate in and lead ACOs,” Wilson said.
I think there’s a reasonable chance that physician led efforts will prevail long term, once the high cost of hospital-led ACOs is better understood. In my opinion it would be better to help physicians get out ahead now rather than have society learn its lesson the hard way.December 3, 2010