Thank you, so much, Dr. Unell, for bringing to light this very important and serious issue. I knew you could do a much better job than myself in explaining how Accountable Care Organizations work and their drawbacks. The fact that CMS has been experimenting on traditional Medicare beneficiaries with alternative payment plans that can harm patients without their knowledge or consent since 2010 and often, no alternative, is reprehensible and amoral. This is CMS's way of railroading traditional Medicare beneficiaries into Advantage type plans but behind their backs even though it has been proven over and over that Advantage plans cost Medicare more than traditional. I am glad you pointed out that ACO's are supposedly held to "quality" metrics, but "quality" is neither quantified nor qualified...apparently it is subjective and like you said, every ACO gives themselves "A's." Thank you so much for a great article; now, if only this can make national news, I would be so happy!
Thank you for covering the important ACO topic. The idea of incentivizing providers and patients toward preventive care and not over-utilizing services seems good on the surface but is better described as you did — a bait and switch scheme. Such an “experiment” is an excuse for keeping funding insufficient. Medicare overall pays providers below market rates, so fewer and fewer providers and facilities accept it.
If you start in TM and find access difficult you’re incentivized to enroll in Medicare “Advantage” or supplemental insurance, shifting costs to patients. Now a commercial insurance company adds its administrative costs and ridiculous overcompensation of its c-suite executives. Providers are paid a bit more, so access to care is better some areas but not others.
And we have the complexity and hassle of the Open Enrollment period navigated by elders, the disabled and insurance agents. What an unnecessary and inefficient mess!
I agree 100%. Congress and CMS have been angling for decades to provide inadequate, low quality, low budget rationed care for Medicare beneficiaries whether they are in Advantage or, now, ACO's as both have the same financial incentives. It was apparent way back in the 90's when privatization of Medicare was allowed that Congress and CMS did not care about the health seniors. I guess, due to our age, we are just no longer worthy of being kept alive.
Thank you, so much, Dr. Unell, for bringing to light this very important and serious issue. I knew you could do a much better job than myself in explaining how Accountable Care Organizations work and their drawbacks. The fact that CMS has been experimenting on traditional Medicare beneficiaries with alternative payment plans that can harm patients without their knowledge or consent since 2010 and often, no alternative, is reprehensible and amoral. This is CMS's way of railroading traditional Medicare beneficiaries into Advantage type plans but behind their backs even though it has been proven over and over that Advantage plans cost Medicare more than traditional. I am glad you pointed out that ACO's are supposedly held to "quality" metrics, but "quality" is neither quantified nor qualified...apparently it is subjective and like you said, every ACO gives themselves "A's." Thank you so much for a great article; now, if only this can make national news, I would be so happy!
Sue
Alan,
Thank you for covering the important ACO topic. The idea of incentivizing providers and patients toward preventive care and not over-utilizing services seems good on the surface but is better described as you did — a bait and switch scheme. Such an “experiment” is an excuse for keeping funding insufficient. Medicare overall pays providers below market rates, so fewer and fewer providers and facilities accept it.
If you start in TM and find access difficult you’re incentivized to enroll in Medicare “Advantage” or supplemental insurance, shifting costs to patients. Now a commercial insurance company adds its administrative costs and ridiculous overcompensation of its c-suite executives. Providers are paid a bit more, so access to care is better some areas but not others.
And we have the complexity and hassle of the Open Enrollment period navigated by elders, the disabled and insurance agents. What an unnecessary and inefficient mess!
I agree 100%. Congress and CMS have been angling for decades to provide inadequate, low quality, low budget rationed care for Medicare beneficiaries whether they are in Advantage or, now, ACO's as both have the same financial incentives. It was apparent way back in the 90's when privatization of Medicare was allowed that Congress and CMS did not care about the health seniors. I guess, due to our age, we are just no longer worthy of being kept alive.