Doctor-Patient Relationships : The Unforeseen Cost of ACOs

A KevinMD article this week by Randell S. Bock, MD examines “How an ACO will affect the relationship between a doctor and a patient.” Just as the title states, ACOs (Accountable Care Organizations) will negatively impact the critical relationship between doctor and patient.

As Dr. Bock explains, “Today, very few patients have a relationship with a single doctor.” This is sad but true, and it serves as a motivator in SignatureMD’s model of personalized medicine, which is based on fostering connections between doctors and their patients.

One of the reasons many doctors lack the intimate and communicative relationship with their patients is because they have to “deal with increasingly larger supervisory medical organizations…” The impending implementation of ACOs means more interaction with medical organizations and less involvement with patients.

In addition to that fundamental issue, ACOs also:

• encourage market consolidation and concentrate power in fewer organizations (like the hospitals), driving innovation, entrepreneurship and competition out of the system
• force the fielding of an “untested system”
• fail to encourage patients to take greater responsibility for their own health care
• fail to directly incentivize higher quality of care, rather than the quantity of procedures

Dr. Bock sums up some of the biggest threats of ACOs: “Hospitals, positioning themselves to become integrated systems join forces: purchase some physician practices ignoring others; choose separate, non-conflicting geographical areas — spheres of influence, in a real-life version of the boardgame Risk. Crowding out the smaller hospitals and independent doctors will result in decreased competition and lessened innovation. These new larger entities, contrary to the stated designs of the ACO-plan, can use this greater leverage with insurance companies to drive health-care costs higher.”

It is likely that solo practices will be forced to close and will ultimately decrease the number of primary care physicians when our country actually needs more. With this forbidding risk, SignatureMD sees this time as a pivotal opportunity to consider concierge medicine. This growing model of medicine allows physicians to focus on patients, rather than paperwork; it encourages individuals to take control of their own health and set wellness goals; and it allows everyone to have more security and more control over how they want to live their lives.

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