Call them what you will, new schemes to control costs come down to doing less for patients.
ACOs are also popular -- with the folks creating them and with "payers," the HMO corporations and government agencies.
President Obama's "Patient Protection and Affordable Care Act" allows these mega "payers" to transfer their gatekeeping role, insurance risk, and black hats to mini ACO partners at the bedside.
The aim is to turn high-cost culprits -- clinicians allegedly driven to venality by receiving a fee for each service -- into paragons of the good social behavior of low-cost rationing of care on a fixed budget for the yearly cost of each patient's care.
This "payment reform" facade is "... pushing providers to implement systemic changes that deliver better care for less."
There is not much "patient protection" in this kind of scheme.
The common slogan "pay for quality, not quantity" is code for gatekeepers decreasing the quantity of payer money "spent" on patient care. Profits (aka "savings") generated by parsimonious ACO gatekeeper behavior are split among the ACO corporation and "payers." The goal envisioned by some is to become one very large merged insurance corporation delivery system "health service."
It is ironic that to legalize Obamacare ACO implementation and massive mergers, the "Patient Protection" law requires federal waivers from patient protection laws. These are waivers for ACO violations of anti-trust law (mergers of colluding providers) and of federal self-referral laws and state anti-fee splitting laws (corporate "gainsharing").
Patients need protection from mega and mini third parties seeking to profiteer from gatekeepers' "shared" profiteering schemes.
Mega managed care gatekeeping has failed at cost control for decades. Recent federally funded mini ACO experimental trials have failed to show significant changes in quality of care or cost control.
It's unfortunate when no one questions the futility of yet another managed care cost control "cure" or even asks about the real economic forces that drive cost inflation.
Robert W. Geist, of St. Paul, is a retired physician.
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