Who is responsible for quality and cost of healthcare in America?in DoctorsACO
Government, Insurance Companies, Physicians or Patients? I am excited to be joining Dr. Doy Gay, in inving all independent Georgia physicians to join Doctors Accountable Care Organizaon (Doctors ACO). The Centers for Medicare & Medicaid Services (CMS) established the ACO system in an eiort to give physicians the opportunity to manage healthcare spending for their Medicare paents.
As physicians, we are responsible for every dollar spent on our patients. In a study on the structure of Medicare, the Henry J. Kaiser Family Foundation divided the total Medicare expenditures by the area in which they were spent. As you can see above, in 2012, physicians were only paid 13% of all Medicare spending for services rendered. So where did the rest of the money go?
In an article featured on USAToday.com on September 4, 2013, this waste is clearly explained. “MedPac, an independent body financed by Congress that provides advice on Medicare issues [found that] services once billed as physician visits increasingly are billed at higher hospital outpatient rates — even if they remain in the same location. Compared with rates in physicians’ offices, Medicare payment rates for (office) visits are 80% higher and echocardiograms are over 70% higher when billed as outpatient services even after adjusting for differences in packaging,” the commissioners wrote in their 2013 Report to Congress on Medicare Payment Policy. In 2011, that difference translated into $1.5 billion in higher bills for the Medicare program and beneficiaries than if they had been billed as
Physician office services, MedPAC reported.”
As physicians, we have a social responsibility to prevent health profit centers from wasting healthcare dollars without improving overall quality of care.
An article published earlier this year in the Wall Street Journal stated that, “Nearly half of the 114 medical practices that began Accountable Care Organizations in 2012 slowed Medicare spending in their first year.” So while health profit centers started charging 70%-80% more for services than private practices - that same year, physicians involved in ACO’s were SAVING Medicare dollars. I believe Doctors ACO will give physicians a chance to improve quality care for Medicare patients.
Paul Haver, MD, has over 24 years of experience and practices Family Medicine and in Athens, GA.