Implementing Accountable Care?

Accountable Care OrganizationsBig news!  The Mayo Clinic in Rochester says it already is accountable to patients without the government’s proposed oversight system and is not going to participate in the Accountable Care Organization as it currently stands.  Mayo says the proposed regulations from the federal Centers for Medicare and Medicaid Services (CMS) conflict with the way it runs its Medicare operations (which treat about 400,000 patients per year).

ACO’s are not the way to go and we’re glad to hear that the Mayo Clinic is making their disagreement public.

Mayo sent CMS a nine-page letter this week outlining problems with the accountable care organization rules, along with suggested fixes. But in an interview Friday, Dr. Douglas Wood, Mayo’s chairman of health care policy and research, suggested that the gap between Mayo’s way of staying accountable and the government’s regulations may prove too wide to bridge.

Among the clinic’s biggest concerns is the government’s demand that patients be included on oversight boards that judge performance. Mayo doesn’t do that now and is not eager to change.

“You don’t have to have a [patient] on the board to make [treatment] patient-centered,” Wood said.

A bigger sticking point could be antitrust rules that are part of the ACO proposal. Mayo already provides most or all of the health care in many of Minnesota’s rural counties, and Wood believes it could not operate ACOs in those areas without violating the proposed regulations.

Another issue is the way the government plans to measure effectiveness and its way of assigning patients to ACOs. The effectiveness measures proposed by the government are such things as 30-day mortality statistics and the number of diabetes treatments, Wood said.

“They don’t get you close to measuring health,” he maintained. “The simplest measure for consumers is: How effectively did the organization keep me functioning. People feel strongly that they want to be able to do what they need to do so that people who depend on them can continue to depend on them.”

Mayo is confident enough in its current approach to accountable care that it has asked CMS “to take an entirely different approach to implementation of ACOs in the country.” Mayo would like the government to contract directly with groups that are already providing programs.

CMS declined to comment on Mayo’s concerns.


If you are uncertain what this all means, here are a few older blogs to help clarify things:

Accountable Care Organizations: Accountable how, to whom, and how does that work again?

The Affordable Care Act of 2010 (ACA), the new federal health care law, in trying to create this coordinated, efficient, top-down health system model, points toward three large organizational structures to accomplish its goal: The Health Benefit Insurance Exchanges (one in each state), consolidation of health insurance companies (the eventual result), and Accountable Care Organizations (ACOs). Here I want to briefly address the ACOs, and will leave the others to another time.

Who is Accountable in Accountable Care Organizations?

Accountable Care Organizations (ACOs) are a rehashed version of the failed closed HMO model of the 1970s and 80s, where the government poured millions of dollars into private enterprises that supposedly were rewarded when they kept the patients well. Once the federal dollars dried up, these entities failed under the heavy weight of their own bureaucracy and the insatiable demand for the free care that was expected.

ACOs Waste Millions of Dollars Chasing Unconstitutional ObamaCare, According to Healthplan Expert

Accountable Care Organizations (ACO) are new entities spawned under ObamaCare that provide for any hospital inpatient service to be paid as a single lump sum to an administrative body. This entity will then in turn pass a portion of the money on to the hospital, doctors and ancillary healthcare providers rendering services during an individual’s hospitalization. Dr. Wayne Iverson, who has hospital attending staff privileges, holds an MBA and is an expert in healthplan development, says, “The new law establishes an expensive new administrative body that has all the functions and operating costs of an HMO without the safeguards HMOs have under state and federal law. With payments to hospitals and doctors already at very low insolvency levels, this additional drain will precipitate a financial crisis in the medical community.”

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