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Accountable Care Backgrou
Specific Concerns
Winners and Losers


Accountable Care Organization Criticism


Insofar as an ACO is a voluntary organization of  physicians, and organized for the purpose of sharing savings as revenue, patients may be quick to relate any deficiency they perceive in their healthcare as being due to greedy doctors.


Whether this manifests as “that CT scan that was not repeated”, “the ChemoTx that was not offered as it was futile”, the “just several more days in the ICU or hospital” that were not allowed, it will be viewed by patients and their lawyers as grounds for suits.


And in court, no amount of relying on guidelines is going to absolve a doctor or the organization from demonstrating a specific individual responsibility to the specific patient at that specific time and place.  Guidelines will never replace individualized doctor-patient relationships and responsibility in a court of law—please see the attached article “Winners and Losers”.


Not to mention that in a court of law reliance on guidelines, or quality measures will be meaningless when the plaintiff lawyer asks: doctor, isn’t it true that denying this test/care/surgery/treatment/expensive medication/ etc., helped your bottom line that year ?


We will be essentially defenseless.  And potentially subject to punitive damages that are not covered by any of our malpractice carriers.


Additionally, an ACO will represent deep pockets, with payouts potentially in the millions, which will attract lawyers from far and wide.  Not letting their physicians represent deep pockets has been a strategy of the NJ malpractice company NJ Pure.


On the whole,  ACOs may help the government maintain the status quo re lack of malpractice reform, and if it saves money, will justify the government’s position that malpractice reform is not needed.


My own view is that ACOs are presently the only method the government has any credibility in, expecting to rein in healthcare costs without loosing votes.  We should all band together, physicians and healthcare facilities and health care workers alike, and hold out for a complete change in the malpractice system to one akin to workers’ compensation:  a fair system of adequate payments for injuries, regardless of the cause, with much cheaper no fault insurance and no more windfalls for the lawyers who now pocket the lion’s share of payouts.  If we don’t hold out now—when the government really needs up to join ACOs, then when will we?