The ACO power grab and those who stand to profit from it

The President of the United States has a broad knowledge of the affairs of his minions; harassing critics of Obamacare is not ok. Photo: Adam Dorin, M.D.

SAN JOSE, May 20, 2013 - Get ready, dear America, health reform’s newest brain child, the Accountable Care Organization (or ACO), is coming to a neighborhood near you.

ACOs have been compared to the HMOs of years past (and present). Some have compared ACOs to ‘mini-HMOs’, encompassing regional power structures caring for thousands of patient lives, which will ration a shrinking pie of health care money to a select group of medical providers.
By law, ACOs must care for a minimum of 5,000 patients, and are ostensibly designed to streamline health care services. ACOs will designate   ‘favored’ doctors and medical practices, study and apply over sixty government-mandated ‘metric’s for quality outcomes, and manage a diminishing pool of money for Medicare/Medicaid patients.
The hidden risk of ACOs not mentioned by those supporting the ‘Affordable Care Act’ is akin to the principle of nepotism on a large scale; that is, local hospital administrators and medical society leaders (and major health system insurers) will have near absolute power to shun enemies, reward those who play by their rules, and promulgate what many fear will be capricious decisions shrouded beneath the cover of ‘reform’.
The officers and board members of these ACOs will primarily be people who already have jobs. Their ACO positions will afford an opportunity to carve out a richer niche for themselves and their practices and institutions.

These individuals will be paid to sit around the ACO table. They will make money from their positions of influence. A tragic consequence will be that some of the most competent, high quality doctors and clinics in the neighborhood will be denied access to the ACO network, thus precluding patients from receiving superior services.
By buying up medical practices, and controlling the narrative on what constitutes the best ‘evidence-based medicine’, hospital executives will be practicing medicine without a medical license.  Instead of letting the marketplace dictate patient preference, a few elite ACO board members will now form the community version of the much denigrated, federal-based Independent Payment Advisory Board (IPAB).
The government will tell you that by working to combine computer information systems between doctors’ offices and the central ACO command (a costly process that could stretch well beyond a decade), and by  rewarding only those providers who cooperate with their rules, that patients will ultimately benefit. If this is so, it will defy decades of dissatisfaction with government-controlled entities like AMTRAK and state Motor Vehicle Administrations.
Those individuals proffering the benefits of Accountable Care Organizations should first disclose to their audience what financial benefits they will personally gain by leading/creating/running these hierarchies of community-controlled medical services. In other words, the public should be apprised of all conflicts of interest that exist for executives and board members of ACOs.
Hospital medical staffs should be told which Medical Executive Committee members are being paid in any way (including hospital exclusive contracts, medical director stipends, etc.) by the hospital/health system owners. Without this knowledge, opponents of Obamacare could be harmed by dubious and self-serving actions which thwart their own personal careers in order to pave the way toward a more profitable implementation of the new law.
As ACOs ramp up in your neighborhood, beware America. Big Brother is now your doctor’s boss.

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Adam Frederic Dorin, M.D., MBA

Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in San Diego. He is a small business owner, a Commander in the US Navy Reserves, and the Founder/President of America's Medical Society, Inc., (AMS) a non-profit corporation created to serve and educate physicians and the general public in matters of national health-care reform and medical politics

Contact Adam Frederic Dorin, M.D., MBA


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