Burlington Free Press

The newest trend for health care reform is “accountable care.” In 2006 Elliott Fischer of Dartmouth proposed this new kid on the block to reform our health care woes and created the name, Accountable Care Organization (ACO). Vermont’s Fletcher Allen Healthcare and New Hampshire’s Dartmouth Mary Hitchcock have formed OneCare Vermont touted as the country’s first statewide ACO.

Defining ACO is a challenge, but goes something like this: a consolidation of, foremost, a hospital and provider practices, as well as health insurance companies with the goal to curb health care costs, improve coordination and quality of care.

For this “novel and innovative” consolidation, the ACO and providers get a financial kickback to care for people. OneCare Vermont ACO has begun to send notification letters to Vermonters covered by Medicare.

I argue that truly accountable care, as well as high quality, coordinated and appropriate care, has been practiced for years in Vermont through the delivery of formerly called general practice now labeled “primary care.” However, as management is sometimes wont to do, the frontline is not consulted. Instead, hospitals and insurance companies are buying out practices to build their fiefdom under the ruse of the accountable care organization.

Meanwhile FAHC pushes for over $120 million in capitol expenditures to pay for an unnecessary expansion to build a boutique medicine inpatient unit that will attract all the cardiac patients drawn in from their frequent and, I imagine, costly TIME magazine advertisements (Same magazine that printed Steve Brill’s expose on outrageous health care costs). Shouldn’t we ask, why more hospital space when inpatient admissions are down in 2012, most likely related to folks avoiding care because of prohibitive out of pocket costs?

Someone should investigate how little FAHC invests in primary care compared to specialty training. The public pays for that crucial discrepancy since doctor-residency training costs are paid by Medicare funds. And when public health carries the best punch for money spent to promote health, UVM-FAHC bedfellows can come through with only a certificate, non-degree program to train effective public health personnel.

Vermont does not need another health reform trend called the Accountable Care Organization. Vermont needs a not-for-profit, democratic, publicly financed health system that emphasizes the promotion of health. The Vermont Legislature has the opportunity to expand its Open Meeting Law for non-profit organizations to include hospitals and ACOs. Given our goal for a transparent and equitable Green Mountain health care system, this Open Meeting Law is essential.

I have always found the greatest examples of honesty and thrift through encounters with my patients. Let us preserve these time-honored qualities.
Dr. Anna Carey of Burlington is a family physician at Cambridge Health Center.