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Forget Individual Mandate; Worry About ACOs

May 31, 2012
Written by: , Filed in: Practice Management
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The “individual mandate” to buy health insurance has gotten most of the publicity, but another part of the Patient Protection and Affordable Care Act will have the most far-reaching consequences, including a seismic shift in how Americans will pay for health care.

That was the message at this week’s 2012 Florida Health Care Symposium in Orlando, according to longtime health reporter Carol Gentry of Health News Florida. Speakers focused on the accountable care organizations (ACOs) that the law sets up. Gentry quoted Michael Millenson, president of the Health Quality Advisors consulting company of Highland Park, Illinois, as declaring:

This is a revolution, not reform. This is a complicated future, not an easy one. But it is better for all of us—patients, payers, and for our country.

Notice that he didn’t say anything about it being better for physicians. ACOs would profoundly affect the practice and business of medicine in ways not easily predicted. Among other things, they would shift clout—and money—from specialists to primary-care physicians.

“If it works the way it’s envisioned,” Gentry wrote, “there will be empty hospital beds, since the ACO will find it more profitable to treat patients in the clinic and at home. Power will shift to primary-care doctors, while many specialists could find less demand for their services.”

Barbara Gray, vice president of the hospital-owned health care consulting alliance Premier, said, “This is going to be challenging. It will take leadership. This is hard stuff. We are turning the business model on its head.”

At least, as Gentry pointed out, ACOs differ in one major way from the health maintenance organizations and managed care of the 1980s and 1990s: “the ACO would be governed by hospital-and-doctor groups, not insurers.”

Even if the Supreme Court or a Republican president and Congress eliminate ACOs, something similar will replace it, several speakers said.

“Health care costs have become so egregious, so out of control, that they’re driving everything,” said Brian Klepper, PhD, a consumer-focused health-care consultant from Atlantic Beach, Florida. “If you don’t think [change will] happen, you’re seriously deluded.”

The Florida Sterling Council, a public-private partnership aimed at promoting excellence in both public and private sectors, sponsored the symposium.

Related seminar: The Business of Radiology


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