Medicare Accountable Care Organizations and You

Savings AheadACO AfraidDespite the fact that as a country we spend much more on health care than anyone else in the world, we lag in health care measures when compared to others.  Medicare spends over a half trillion dollars each year, and you can’t blame them for trying to figure out how to lower costs and make sure that the care they are paying for is actually promoting health.  One such attempt is the advent of accountable care organizations or ACOs.  In Maryland there are presently over a dozen of these groups which have formed, and almost every physician or hospital will soon be part of one of them.  We are members of a Medicare certified ACO known as Maryland Collaborative Care which was originally formed by the Maryland State Medical Society.  We have researched them and so far are very pleased to partner with Maryland Collaborative Care.  Some of you may have received a letter from Medicare about our participation in Maryland Collaborative Care, giving you the choice to allow this ACO to view where your health care dollars are being sent.  Once Maryland Collaborative Care ACO has that information, it can share it with us; and we can work together to help you stay healthy.

The theory behind ACOs is that by their promoting information sharing among physicians and hospitals and providing targeted extra resources, you can receive more efficient care with fewer unnecessary tests without duplication of services; and in the end your care will be of better quality.  Like motherhood and apple pie – Who could argue with that?  Or should we be suspicious?  Of course “the devil is in the details.”  For instance what is quality care, how do we measure it, and how do we improve it?  Medicare has created over twenty “quality care measures” to judge us by and the list (and administrative burden) is growing.  There are many ironies here.  For instance one Medicare quality measure is to see if we are providing a depression checklist for patients to fill out.  Yet if we wish to refer someone to a psychiatrist  (good luck finding one),  many mental health care providers in our area don’t accept Medicare because the reimbursements are so low and the paperwork too great.  Further checklists are for risk of falls and all other manner of things, including seeing if we are in compliance with what are now outdated cholesterol guidelines.

The truth is that Medicare’s struggle to contain costs and improve communication with one’s primary care physician is in part due to our collective glamorization of specialty care.  Case in point, we refer you to a cardiologist to make sure your heart is healthy and your tests are thankfully negative.  Nonetheless, when you find yourself going back every six months to get your blood pressure checked by their nurse practitioner with yearly expensive tests that don’t change your care,  should we be asking Medicare to create an organization to reign in those expensive tests and force the cardiology practice to keep Dr T informed?  Might it not be a better choice to have Dr T manage your blood pressure in the first place and let him direct your further care as appropriate?

Repeat that scenario over and over for routine diabetes care, thyroid care, annual prostate checks, etc.; and you can start to see why Medicare finds itself in the position it presently is in: lots of dollars being spent with little to show for it.  If nothing else, remember your time is valuable.  As a board certified internist surrounded by superb staff, Dr T is well equipped to attend to the majority of your care.

ACOs will likely be with us for a long time to come.  We do recommend sharing your health information among all your health care providers.  Your participation in the ACO information sharing is voluntary and can be revoked at any time.  We are happy to answer any questions about these new and evolving Medicare organizations and how they may impact you.


by Dr Ed Taubman Primary Care Physician Olney MD 301-774-5400

Voted Top Doctor Washingtonian Magazine

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