ACOs are another distraction from universal single-payer health care

By Peggy Anna Carey, M.D., Sept. 26, 2012

Fletcher Allen Health Care and Dartmouth-Hitchcock Medical Center have formed their new accountable care organization (ACO) called OneCare Vermont. The stated vision is “a statewide network with a coordinated clinical model and toolset … to enhance the quality of the care provided to Vermont’s Medicare beneficiaries while remaining good stewards of health care expenditures …”

The first question should be what exactly does this statement mean? Am I mistaken, or hasn’t the Vermont Legislature created the Green Mountain Care Board to establish the statewide infrastructure to create our universal single-payer health care system called Green Mountain Care? Does not Green Mountain Care model both high quality and cost-effectiveness by eliminating the morass of administrative waste created by the present health care situation that is virtually run by for-profit corporations?

ACOs such as “OneCare” are a ruse for hospitals, insurers and providers to consolidate more of their clout to control their turf of profits. The Medicare Shared Saving Program that is encouraging the formation of these ACOs is based upon pilot studies that showed little savings and little improvement in care. Amy Goldstein, medical reporter for The Washington Post, wrote over a year ago:

“The five-year test enlisted 10 leading health systems around the country and offered financial bonuses if they could save enough by treating older patients more efficiently while providing high-quality care. In 2010, the final year, just four of the 10 sites, all long-established groups run by doctors, slowed their Medicare spending enough to qualify for a bonus, according to an official evaluation not yet made public. Two sites saved enough to get bonuses in all five years, the evaluation shows, but three did not succeed even once. The uneven progress is significant because the experiment involves ‘accountable care organizations,’ one of the hottest trends in health policy and an idea included in the year-old federal law intended to overhaul the nation’s health-care system.”

In reality, OneCare Vermont ACO is a device for large medical organization like Fletcher Allen and Dartmouth in cahoots with for-profit insurance companies to maintain control of their vested interests. With greater efficiency, i.e., limited care as practiced by the HMO disaster of the 1990s, the “consolidators,” not the patients will get federal monetary kickbacks. If FAHC were truly committed to Act 48 and Vermont’s legislated path to create our universal single-payer health care system, why did FAHC’s CEO John Brumsted rally FAHC specialists, in spring 2011, to testify against the passage of Act 48 that sets Vermont on the path to true health care reform.

And why would Vermont want to CONSOLIDATE health care that is caring and efficient occurring independently in primary care practices across the state? Hospitals are the most costly care organizations not because of the acuity and severity of care they offer, but because of their modus operandi to push for expansion of bricks and mortar as well as expensive technology only to have to pay for these cost overruns by the overuse of costly procedures.

And where do FAHC and Dartmouth medical centers exemplify superior practices of communication between health professionals? As a family physician in Cambridge, Vt., I need to work with three hospitals that my patients use: Copley in Morrisville, Northwest Medical Center in St. Albans and FAHC in Burlington. I receive timely reports from Copley be it specialists’ or Emergency Department records. Repeatedly my staff and I are calling for records of our patients who seem to fall into a black hole of the FAHC behemoth.

Finally, where is the focus on the patient in this duplicitous scheme that rewards financial kickbacks to ACOs for doctors doing their jobs providing good care? Let’s remember that the most important “special interests” are our patients. I have complete faith in Vermonters to see ACOs for what they are, nothing more than the emperor’s new clothes.

Dr. Peggy Anna Carey is a family physician. She lives in Burlington.