Editor’s note: This op-ed is by Dr. Anna Carey, a family physician in Burlington.
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 Health Care (FAHC) and New Hampshire’s Dartmouth-Hitchcock have formed OneCare VT, 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, add in health insurance companies, with the goal to curb health care costs, and 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 VT ACO has begun to send notification letters to Vermonters covered by Medicare. According to an informed doctor friend of mine covered by Medicare, the letter includes no understandable explanation of what the heck an ACO is and, furthermore, requires the individual to take steps to “opt out” if she does not want to participate.
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.”
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 capital 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? Why millions of dollars for an electronic medical record program update when less than 50 percent of the time do I have a timely note from a specialty consultation when I follow up with my patients just 30 miles away? Never mind an actual courtesy phone call.
And we should not forget the illegal machinations of FAHC’s Renaissance Project fiasco of 1999-2002. Some of the present FAHC advocates for this 2013 certificate of need were involved in that ploy that ended with the CEO serving a federal jail term for lying. Seems as if ratepayers are still paying, but FAHC can afford $800,000+ salaries for executives and $500,000+ salaries for radiologists.
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. Finally, who’s to say that a national health insurance conglomerate like United Healthcare or Humana might not opt to buy out OneCare VT to prevent Vermont’s universal Green Mountain Care from being established in 2017.
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 nonprofit 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.