My 81 year old mom received a letter from her doctor, four days before the Affordable Care Act took effect. It was a two page questionnaire titled Personal Health Assessment (PHA) from the Accountable Care Organization (ACO) that her doctor chose to voluntarily participate in, thus enrolling all his patients onto this LLC (Limited Liability Company), a mixture of partnership and corporation. How was the group formed and why?
According to the government website, Accountable Care Organizations (ACOs) are “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” This immediately begs the question, were patients not receiving high quality care before, were doctors not coordinating with each other privately what was in the best interest of their Medicare patients?
The real answer comes in the next paragraph. “The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.” (The boldfaced words are on the website)
Let’s translate the bureaucratic speak. The goal is not to prevent medical errors or give the patient better care, patients already have the best medical care in the world; the goal is to deny care, certain procedures, treatments, surgeries, and drugs to the “chronically ill” and “spending health care dollars more wisely,” potentially saying no to older or sicker patients because they’ve outlived their utility to society. By doing so, the ACO will be rewarded with “sharing in the savings it achieves for the Medicare program.” How do you think this “sharing” will be decided?
The sooner the doctors joined ACOs, the better. For example, the Pioneer ACO Model for early adopters of “coordinated care” is no longer accepting applications.
The next tier up is the Advance Payment ACO Model, a “supplementary incentive program for selected participants in the Shared Savings Program.”
When I see the words “incentive” and “shared savings” I immediately visualize financial reward for the participating doctors who provide less care than the patient may need in order to achieve Medicare savings. Why would Medicare need to save money? Because over the next ten years, Medicare will lose $719 billion in order to fund Obama Care.
At the top tier is the ACO type which my mom’s doctor has joined with other physicians, the Medicare Shared Savings Program, a program that helps a Medicare fee-for-service program providers become an ACO.
Suddenly my mom has become a Medicare Fee-for-Service beneficiary and her primary medical care will come from the participating doctors included in the ACO, and assigned by the Centers for Medicare and Medicaid Services (CMS) of the federal government.
The ACO, according to this letter, is neither a Health Maintenance Organization (HMO), nor managed care, nor an insurance company. “The ACO is a new program developed by CMS for Medicare Fee-for-Service beneficiaries with Original Medicare. Unlike HMOs, managed care, or some insurance plans, an ACO can’t tell you which health care providers to see and can’t change your Medicare benefits. You always have the right to choose any doctor or hospital who accepts Medicare at any time.” What is the problem then, why did you have to change your Original Medicare plan?
The answer is that although you “have the right to choose any doctor or hospital who accepts Medicare at any time,” there is no guarantee that your treatment will be approved and paid for, and that your chosen doctor or hospital will accept you, will accept Medicare of any kind, or worse yet, the chosen doctor or hospital will still be in business.
Why would my mom’s doctor need her to complete a Personal Health Assessment (PHO)? His office already has complete medical records and her history. The ACO and the federal government with whom it shares the data wants to have a complete and accurate picture of mom’s health and needs in their data base in order to more efficiently ration her needed care.
Even though patients have declined to have Medicare share their personal health information with the ACO, they still received this letter in the mail, telling them that “your doctor will continue to work with doctors, hospitals and other health professionals to provide more coordinated health care for you.” In other words, no matter what you say or do, your doctor will still share all your health history with the federal government on the national database.
Don’t worry too much, the Personal Health Assessment (PHA) will be shared as needed with your Primary Care Physician (PCP) and if he/she deems it necessary, he/she may share it with other specialists or providers. But, your privacy is so important to them that they have safeguards in place to make sure that your medical information is safe and confidential.
I am sure hackers and con artists salivating for your personal information are already laughing themselves silly all the way to the bank. I forgot to mention that your healthcare information will be required to have your bank account information.
To prepare patients for end of life counseling which is mandatory in Obama Care every few years, the PHA question number six asks if, over the last two weeks, you had “little interest or pleasure in doing things, and have you felt down, depressed or hopeless?”
Will ACO give you improved medical care? Yes, if you believe in Santa Claus. They say, as long as we can share your information with everyone, they will know everything about your medical care, medications, drug use, smoking habits, sexual habits, and everything else that may help them have a “more complete picture of your overall health.” Will they have the time to assess all this information if 30 more million people will be added to the national patient load while the number of doctors remains the same or less? I seriously doubt it. The ACO is more about citizen control and herding into an “I know everything about you and better behave as I say” government.
Look at the bright side, under Obama Care, you may not be able to keep your doctor as the Democrats promised, but you will definitely keep your nurse or nurse practitioner. On second thought, they may be too busy as well to see you on demand; you may have to wait a few weeks.