Skeptics question whether bigger healthcare networks are better

Bigger does not always mean better, according to some healthcare reform observers.

Some argue that accountable care organizations (ACOs)--those networks of healthcare providers that are designed to cut the cost of caring for patients through better coordinated care--may actually make healthcare more expensive through consolidation, the Washington Post reports.

"The only way to decrease costs that truly works is increasing competition, but for some reason in healthcare, we're supposed to believe that competition drives up costs," ophthalmologist Frank Cotter told the Post.

In Roanoke, Va., what some see as an accountable care organization, others say is a monopoly. Carilion Clinic owns eight hospitals in the Roanoke Valley area and employees 550 doctors, according to the Post. The clinic is transforming its 37 primary-care practices to the medical home model.

Independent doctors worry that Carilion is pressing employees to refer patients only to providers within the Carilion network, using the language of healthcare reform to hide what some consider monopolistic tendencies.

"Now, they say, 'ACOs, that sounds good, let's graft onto that,'" radiologist James Blackwell told the Post. "But the germ of the idea was really, 'How can I get a bigger system with more control, without all these fractious doctors to death?'"

Only half of family physicians in the Roanoke Valley are employed by Carilion, the clinic's officials told the Post in response to the monopoly charge. Plus, a 500-bed hospital in Salem, near Roanoke, is owned by HCA, a national healthcare chain.

While expanding networks might make it possible for providers to eliminate unnecessary care, some health economists say that the savings could be erased if networks drive prices up.

To learn more:
- here's the Washington Post article

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