The Lost Dollars


So there is this thing in the US that you may not have heard about. ACO’s, Accountable Care Organizations, are groups of physicians that have “joined together to provide high quality care” for Medicare patients. So says the CMS (Medicare) website.

What does this mean for patients?

Hell if I know. I don’t practice medicine any differently than I always have except that I find myself spending more and more of my time clicking the requisite buttons in the EHR (electronic health record) so patients get less of me. Quality care is quality care and should be given across the board to all patients no matter what bonus structure happens to be in place. I do have suits that come out and flash PowerPoint slides at me that tell how many of my patients ended up in the ER over the past quarter but I don’t pay attention. Frankly, I should not be making a decision whether or not a patient needs to go the ER based on what my “numbers” may or may not look like. 

What does that mean for physicians?

Supposedly, I get money every year that I can demonstrate that I provided savings to Medicare. If Medicare does not spend as much money but patients still get their colonoscopies and whatever else done (I have no idea how that is supposed to work), then I get a share of the “savings.”

How big is that check?

It is not like winning the lottery, that is for sure. I resent the insinuation that I need to be paid extra to do the right thing, but that is beside the point.

The healthcare corporation I work for requires me to complete some…. tasks… before I get this check.

For instance, I have to attend quarterly regional meetings and log onto two separate websites each and every month. To be honest, none of the physicians I know look at anything on those websites. They log on and log off to get the credit. (Of note, I have asked why it has to be two websites. Why can’t it just be one? No one gives me an answer.)

All of this, if it actually improved patient care, would be fine. But it doesn’t. Not one bit. It turns physicians into cute puppies doing silly tricks for their next treat and I refuse to participate. 

By not participating, however, the corporation gets to keep that check. I might not care about that if I knew it was going to go to helping indigent patients get access to care or some other noble cause but I don’t have the foggiest idea what they plan to do with it…

Personally, I think it should go back to Medicare.


78 thoughts on “The Lost Dollars

  1. I am so pleased I live in Canada. I am sure our physicians have issues but I don’t think twice about seeing a doctor and I don’t have to check my bank balance to go. I was recently in hospital for 6 days. Excellent care, good food and no bill.

    Liked by 4 people

    • Physicians should be the ones delivering and promoting quality care. Evidence based medicine and all that jazz. To be honest, though, I don’t even understand how the ACO system works. Who decides quality and “savings” I don’t know.

      Liked by 2 people

      • In theory there’s a cost benchmark per diagnosis code – so basically what it “should” cost to treat a particular condition as a starting point. Or maybe they start with the average instead of a benchmark – I’m not 100% on that.

        Either way – that’s how they classify the charges and whether there are savings or not – by diagnosis code. People who manage HMO’s have basically been doing something like this for a while.

        Speaking of evidence-based medicine, one of the things I actually liked about the ACA is the PCORI tax – $1 per covered life for health insurance plans that was to go toward researching effective treatments (i.e. adding to the body of evidence-based medicine out there or replacing habit-based medicine with evidence-based medicine).

        Liked by 1 person

      • There are crap loads of things we have thought were “good medicine” that turns out were not actually. Research is a good thing, and we need more of that. I get star ratings and not extra money from traditional insurance plans. I am sure they measure all sorts of things that I don’t pay attention to.

        Liked by 1 person

  2. Everything has become a business. And the businesses who run things think that every person is incentivised by money. They think we all are as greedy as they are, so they dangle carrots expecting us to jump. And some do, but luckily there are a few who actually care about the lives of their patients; not the bottom line.

    Liked by 3 people

  3. Since I have been out of the healthcare business for some time (except as a patient) these ACOs are new to me. There were Health Maintenance Organizations(HMO), Preferred Provider Organizations(PPO) and others. Some were fee-for-service and some were capitated. All were supposed to bring down the cost of healthcare in premiums and claims while providing profits for the insurance companies and more money for physicians. Oh, and better care for the patients. Some succeeded and some failed. I applaud you for simply trying to provide good care for your patients without a financial carrot whose measures are nebulous. As a provider relations representative I saw all types of physicians and prefer to believe that most wanted what was best for their patients. I agree with one of your replies that Medicare fraud is appalling! Keep up the good work, Doc!

    Liked by 1 person

  4. Do you and I work for the same organization??? Hahah! The shared savings at least in my experience is very diluted. The insurance companies (Medicare, etc) get to decide if you saved the money and they get to decide how much and they get to decide if, when, and how much they pay back to the ACO. So basically the physician is screwed. We are working harder to prove the good job that we are doing and getting less pay, the patient is getting less of us, and the docs are getting more and more frustrated.

    Liked by 1 person

  5. I can only imagine why you have to go to two websites, and jump through those other hoops, but the biggest reason is that the people who make these rules up do not work with patients full time if at all and they could not agree on which website to use. Good for you for not buying into the insanity.

    Liked by 1 person

  6. I can understand your resentment of the ACO concept, and I don’t blame you. However, is it possible that the care given by other physicians might actually be improved by the concept?

    My dear departed mother had a physician notorious to me for his reluctance to spend time with her. His waiting room was always packed. After we waited, usually more than an hour, he would pop in and right back out after spending about 5 minutes with us. Clearly, he was enchanted with through-put. I tried to get her to change docs, but she resisted. I don’t know why.

    Liked by 1 person

    • I don’t have a problem with ACOs per se. What I do have issues with are how the money is dispersed in these large healthcare groups. You want to give me money? Cool. Someone else should not be giving me stupid things to do in order to “earn” what I have already earned. If I choose not to take the money, it should go back to Medicare, not to the suits. Will it provide better care from other physicians? In your departed mother’s case it would not help her get her PCP to spend more time with her. That is not incentivized.

      Liked by 1 person

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