Accountability? Heaven Forbid!

PAUL LEVY

Originally published 1/10/11 on Running A Hospital

At a recent talk, Dartmouth’s Elliott Fisher facetiously remarked that we cannot yet be sure whether accountable care organizations (ACOs) will actually be accountable, caring, and organized. Well, if some providers have their way, they certainly won’t be accountable.

This story by Jordan Rau in the Washington Post relates comments being made as Medicare writes its rules governing the ACOs. Here are some quotes: 

[S]ome prominent doctor and hospital groups are pushing for features that some experts say could undermine the overall goal – improving care while containing costs. They’re seeking limits on how the quality of their care will be judged, along with bonus rules that would make it easier for them to be paid extra for their work and to be paid quickly.

Here’s the one I like best:

The Federation of American Hospitals, representing for-profit facilities, goes further, urging that ACOs be allowed to choose their patients. “Providers are better positioned than CMS to determine which of their patients would be appropriate candidates,” the federation wrote.

So, we are happy to be held accountable, but only if we get to choose which patients are part of our network.

And, how about this from the American Medical Association?

The medical association doesn’t want surveys of patient experiences to be used in evaluating ACOs.

Right. What do the patients know, anyway?

And from my soon-to-be-former hospital association:

In the dispute over financial incentives, the American Hospital Association is pushing CMS to let providers collect bonuses early on and in full rather than having some of the bonuses deferred as an added incentive to keep up the good work.

Collect bonuses before you earn them? Of course.

One thought on “Accountability? Heaven Forbid!

  1. I’ve been a practice administrator for large single specialty groups for 14 years and the great unwritten law among them was that “you don’t tell me how to practice medicine and I won’t tell you how to practice medicine”. I remember taking the better part of a year to try to standardize a one page form for echo interpretatinos between two office from the same group. They are deathly afraid of the concept of transparency. Interoperability and social networking are getting ready to change that but it won’t be easy and you can expect special interest groups that represent hospitals and physicians to fight it every step of the way.

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