The announcement by the Centers for Medicaid and Medicare Services (CMS) to move 50% of its non-managed care spending into Accountable Care Organizations (ACOs) and bundled payments coupled with the recent passage of Medicare Access and CHIP Reauthorization Act (H.R.2) the repeal of the so called ‘doc fix’ will lead to the end of private healthcare, narrow the range of medical services offered by physicians, and increase the cost to patients and taxpayers.
It will not accomplish the goal of improvement of outcomes or increase access to healthcare for Americans. Instead, these changes will likely further decrease access for the sickest patients and decrease the quality of care for patients overall. If physicians and hospitals are now to be rewarded for positive outcomes, they will skew their services to healthier patients if for no other reason than to remain open. Under the ACO model members will receive a prescribed amount of money each year. The organization will access this ‘pot’ to deliver all medical services – tests, admissions, procedures and office visits. At the end of the year, members will share in the money left over. This model will inevitably put pressure on clinicians to avoid providing costly services and steer sicker patients to palliative care (hospice), and will most assuredly discourage doctors and hospitals from offering care that will be considered expensive. Doctors who work in this model will be in the business of acting as agents for a system that is driven by external dictates that place an artificial value on an individual and will destroy patient privacy. What was initially billed as a choice is now the law under H.R.2. It sounds good until it hits home when a patient needs the service that is denied because he/she is too old, too sick or otherwise is not deemed worthy because of a dire and/or costly diagnosis.