ACOs scare patient advocates

Patient advocates are leery of accountable care organizations, the New York Times reports.

While the healthcare reform law--which authorized the creation of ACOs (ACO news)--is designed to push doctors, hospitals and other healthcare providers to collaborate and jointly take responsibility for raising the quality of care and cutting the cost, some health industry observers are concerned that the ACOs could hurt patients.

Judith A. Stein, director of the nonprofit Center for Medicare Advocacy, notes that some health organizations may try to hold costs down by "cherry-picking healthier patients and denying care when it's needed." But Medicare may penalize organizations that attempt to avoid high-risk, high-cost patients like those suffering from disabilities and chronic conditions.

Peter Thomas, a lawyer for the Consortium for Citizens with Disabilities, echoes her concern about how ACOs will affect patients. If healthcare providers are financially rewarded for keeping costs down, he says, anyone with a disability or a chronic condition, or anyone who needs specialized or complex care, needs to worry about getting access to the right technology, medical devices and rehabilitation. "You don't want to save money on the backs of people with disabilities and chronic conditions," he says.

Elizabeth Gilbertson, chief strategist of a union health plan, thinks the consolidation of healthcare providers could translate into higher prices. She likens some markets to solar systems where the hospital, which owns physician groups, surgery centers, labs and pharmacies, is the sun. Because ACOs bring more planets into the system and strengthen the ties that bind them together, they increase the hospital's power and by extension, its ability to raise prices. "That is a terrible threat," she says.

To learn more:
- read the New York Times story

Related Stories:
Internal CMS schism slows ACO payment rule development
New Hampshire Blues, Dartmouth-Hitchcock move toward ACO
Physicians, hospitals rush to form ACO alliances
Physicians stress flexibility with ACO models

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.