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Wednesday, 01 August, 2018

Ted's Take: Patient Choice

What does patient choice really mean in the new world of payment models? There are Accountable Care Organizations (ACOs), which include hospitals and physician groups many formed by large health systems, and there are bundled payment platforms, which include many of the same modalities as ACOs. But, with so many people placed into broad payment models, is there really choice?


Today, ACOs and/or their sponsoring health systems are buying large physician practices. Medicare beneficiaries are often assigned to the Medicare ACO that includes their primary care physician, but there is no requirement a patient be told. Most patients don’t even know they’re in an ACO. The goal is for health providers to operate more efficiently.


Not too long ago, public voiced concern over Health Maintenance Organizations (HMOs). Many believed that there was an incentive for HMOs underserve patient to the exclusion of quality for the reward of making money.  I find it interesting that those same concerns have not been raised about ACOs. Consider that Medicare allows an ACO to determine what quality measures should be used to evaluate themselves (rather than the required Medicare measures).


But back to patient choice. Under Medicare, a patient can select his or her own primary care physician and can receive treatment from any Medicare provider. However, once physician practices or other practices are acquired by an ACO, such choices may not be offered. With the waiver of Stark Self Referral requirements for ACOs, the ACO is not required to inform the patients of provider options outside of the ACO.



Is it patient choice if the patient does not know choices exist? I think not.



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