The old model of medical care had the patient’s personal physician heavily involved at every step of care, paid per service performed. Under the model used by Accountable Care Organizations (ACOs), the patient is instead cared for by a series of professionals. In the physician’s office, nurses and physician’s assistants play a larger role in medical care. If the patient has to be hospitalized, instead of the personal physician coming to the hospital, a specialized hospitalist doctor takes responsibility for the patient’s care until the patient is discharged. The entire network of professionals is paid a lump sum (distributed across the various care-givers) for caring for the patient rather than per service performed.
Goal of the ACO
ACOs are becoming more popular because it is hoped that they will both improve patient care and reduce costs. The fundamental idea behind ACOs is that they will be rewarded for getting patients healthy and keeping them healthy by paying per patient instead of per service, and by paying bonuses to ACOs for meeting quality and health criteria. Under the current fee-for-services health care system, healthy patients tend to not earn health-care providers much, if any, money. In fact, under the current system, there are financial disincentives for health-care providers to try to keep patients healthy, and instead health-care providers are rewarded for scheduling unnecessary tests and appointments.
Standardization of care
In addition to reducing unnecessary testing and appointments, one major impact ACOs have on medical care is standardization of care across patients and professionals. Rather than allowing physicians free reign in applying professional judgement, ACOs encourage the use of clinical practice guidelines and written protocols for managing each particular condition.
The downstream impact of standardization of care is unclear. It might improve patient care. It will definitely affect the legal environment for example, if all of the ACO professionals followed the standard protocol in treating the patient, can they be found to have committed malpractice if the patient has a bad outcome and sues? Perhaps the ACO can be found to have committed malpractice by endorsing an incorrect treatment protocol, or defining the patients to be treated by the standard protocol incorrectly. Shifting the liability for malpractice from the health-care provider to the ACO may reduce costs- health-care providers will no longer need to practice “defensive medicine” in case of being sued.
ACOs also improve communication across health-care providers. ACOs coordinate patient care across their network of health-care providers, relieving patients of that responsibility. Specialists have direct access to patient data rather than having to rely on patient recall or re-running the same tests. Rather than the hospital writing out discharge instructions and then dropping out of the picture and hoping the patient follows the instructions, the ACO builds infrastructure to directly communicate between the hospitalist and the patient’s physician to increase patient compliance with followup care, in hopes of reducing re-admissions to hospital.
The concept of health-care providers working to keep people healthy and reduce costs is very appealing to some patients. Some patients, however, might prefer the idea of having one single trusted doctor rather than a network of unknown health-care professionals. Some doctors might find the ACO environment frees them to practice preventative healthcare, but others might dislike being told how to treat patients by ACOs, and others might dislike the idea of not being involved in all aspects of their patient’s care. We will have to wait and see which medical model wins out in the future.