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Accountable Care Organizations Waltzing With Medical Professionalism
After the release of the proposed regulations last Thursday, it’s clearer what Accountable Care Organizations (ACOs) will look like. They just might be the means to realize medical professionalism in the 21st century.
I see ACOs helping us achieve optimal quality, patient experience and cost of health care in the U.S. as outlined in the Physician Charter. ACOs will be responsible for the quality and costs of a defined set of patients with shared saving arrangements. Multi-specialty group practices and integrated hospital systems are likely the best candidates for leading ACOs.
ACOs like prepaid group practices (such as Kaiser Permanente, Group Health Cooperative) will afford physicians the opportunity to gain control over their practices by granting them “self-determination” of the rules surrounding rational coverage decisions and alignment of payment with appropriate use of services.
ACOs have the potential to respect patient autonomy and patient welfare while optimally delivering health care services. It trades public accountability, as in transparent quality measures and cost information, for less interference from insurance companies and more autonomy in medical decision-making. These are the aspirations of medical professionalism in the 21st century.
Achieving these quality and cost goals in ACOs will require a culture based in respect, interprofessional team-based care, better care coordination, and successful information sharing and communication between clinicians and an engaged patient.
ACOs maybe the last great hope of medical professionalism in the 21st century. If ACOs and the like fail, and resulting cost and quality gains are not met, the ideals of medical professionalism are in jeopardy.
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