ACO’s vs. HMO’s and the Coming Failure of ‘Accountable Care’
Up to 98,000 Patients Die Each Year in the Hospital as a Result of Preventable Medical Errors
A Letter to the Country from an Emergency Room Physician
The ACO (Accountable Care Organization) concept is the already failed model of the HMO (Health Maintenance Organization)- same pig, different lipstick. If this gets sold nationally the public really doesn’t understand economics. You don’t meet a rising demand in consumption with a payment model predicated on lowering productivity which is exactly what HMO’s and now the “new” ACO models are designed to do.
The government is complaining about the cost of healthcare due to the simple fact that it is rapidly becoming the payer for these services. The more society allows fewer payers for healthcare the more demand for cheaper care there will be. Cheaper is not better and many of us are already wanting something better than what is being delivered.
A recent report published in JAMA revealed some harrowing facts about the failure of our strained hospital system. Payment controls and other regulations are causing physician workloads to exceed safe levels which results in the death of patients. The hospitalist model of care is hurting patient outcomes. Never before has it been so important to have your primary care physician advocate for you in the hospital. As more payment controls placed by the government’s fixed pricing model reeks more havoc, we are seeing the problems arise. As this situation gets worse, we may start demanding more free market choices and a reassessment of the command and control planning that Medicare and the other 3rd party payers seem to be promoting. It is time for consumers to stand up for themselves, after all – it’s your money and your life! Read More>>
I am an emergency physician with an apolitical message in this rather politically charged, polarized time in our country. I have worked for some time in this profession, and have noticed a disturbing trend about which I must speak out — the growing number of emergency department scenarios in which the selfishness and entitlement of those without real emergencies drown out the quiet suffering of those in real need.
Patients Cared For by Hospitalists are More Likely To Be Discharged to Nursing Home Facilities and Have Emergency Department Visits
Care of patients by hospitalists instead of their primary care physicians has grown rapidly in the past decade. This growth has caused discontinuity across transition from inpatient to outpatient settings, poor communication of important information, medication errors, and a decreased likelihood to be discharged to home. A 2011 analysis showed that patients cared for by hospitalists were less likely to be discharged to home (odds ratio, 0.82 [95% CI 0.78 to 0.86]), and were more likely to have emergency department visits (odds ratio, 1.18 [95% CI 1.12 to 1.24]) and readmissions (odds ratio, 1.08 [95% CI 1.02 to 1.14]) after discharge. They also had fewer visits with their primary care physician and more nursing facility visits after discharge.
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