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Friday, February 17, 2012

Remember how HMOs gave physicians more autonomy,ACOs will be even better

Remember how HMOs made patients happier,doctors more satisfied with their work and also brought about better care while bending the cost curve downwards. Well, we are told that ACOs will do that only even better.

Dr. Ezekiel J. Emanuel , in this commentary, in JAMA assures physicians who might have foolishly worried that joining an ACO would lead to some loss of autonomy. He and his co-author argue that actually ACOs offer the opportunity for more ( not a typo ) autonomy.

So how does working with (for?) a large vertically integrated organization which by definition will have a large bureaucracy lead to autonomy?

Here is quote from Emanual's article that suggests one way.

More relevant to physicians' autonomy, the ACA initiates payment reforms that will give physicians greater financial flexibility to redesign care delivery, and to provide services that may not have been reimbursed before. For example, traditional fee-for-service payment mechanisms do not reimburse for efforts to enhance medication compliance or to oversee the results of wireless physiological monitoring in patients' homes.

and more

Another provision of the ACA that offers physicians more liberty to pursue patients' best interests is the move toward accountable care organizations (ACOs), which are combinations of physician groups, hospitals, and other providers that will coordinate care for patients.6 The proposed ACO regulations require physician leadership and empower physicians to determine the information systems and infrastructure necessary for coordinating care. The freedom to redesign care occurs along a spectrum depending on how the ACO is paid.

Does anyone who has worked with the administration of a large hospital or an insurance company really think that the typical ( or atypical ) physician is going to "determine" much of anything."Freedom to redesign" ? More like freedom to follow the rules and guidelines of the organization or seek employment elsewhere.

Some of us may have been fooled or seduced or coerced by the HMOs , fool me twice...

Surveys have indicated a number of physicians will leave practice early because of Obamacare.I guess the prospect of greater autonomy is just too frightening.


Andrew_M_Garland said...

The average person hasn't yet seen government control of his profession close up, except in medicine, banking, and auto manufacturing. Why can't knowledgable, fact-based, systematic government oversight bring community and efficiency to everyone ?  (sarcasm)

Thomas Jefferson: “A government big enough to give you everything you want is powerful enough to take everything you have". The dramatic increase in government regulation and direction of private business is killing business activity. Who wants to invest in many years of risk and hard work, to end up controlled and directed like a government worker, taxed to death by the government as a "person of too much wealth".

The Department of Work and Production

An encounter of an ordinary guy with a government agency that is going to make his profession more efficient, and save or increase his salary.

JDar said...

At least computerized medical records will eventually make practice so much easier for those whose choose the profession in the future.

The switch from video games and the experiences of social networking over to modern medicine and making choices on the HHS medical menus will be so much easier than having to think about individual health care consumers. Now that's autonomy.