Letters discuss ACOs, decision-making, and electronic health records.
The article by Michael Brown, CHBC, was very well written and is great advice for any prudent healthcare manager to follow ("Will we all be hospital or government employees?" [From MedEc], September 24 issue).
Will ACOs become reality?
It is clear that those of us in the business of providing education and advice to physicians and hospitals have an uphill battle to help them understand how collaboration, information sharing, and a willingness to compromise on decision-making about patient care are going to prove so important in achieving the goals of quality improvement and cost reductions within an ACO. Physicians are, by nature and by training, strong decision-makers. They gather as much relevant information about a patient's condition as they can assimilate, they consult with colleagues when they consider it necessary, they form a plan of care, and they carry it out. As explained in the articles by Dr. Frank and Dr. Herington, once the plan has been formulated, some physicians are a bit rigid in considering other options to achieve the goal of improved patient health.
As explained by Dr. Carney, hospital administrators often suffer from similar rigidity when it comes to charging for services rendered to uninsured patients. Of course, there are lots of different systemic reasons why inflexibility has become so prevalent in the practice of medicine. Professional liability risk aversion and the government's assumption that all healthcare providers are constantly tempted to commit fraud are just two that come to mind. Nevertheless, if physicians, hospitals, payers, and
patients cannot begin to be more open-minded and listen to each other, the dream of accountable care based on quality outcomes, cost efficiencies, and patient satisfaction will never become reality. Dr. Carney hit the nail on the head: "It must be a give and take."
RICK RUTHERFORD, CMPE
American Urological Association Linthicum, Maryland
Separation from third parties
I agree with the article regarding electronic health records (EHRs) by Craig M. Wax, DO, and thank him for writing it ("EHRs, insurance, and government: When did we lose sight of the patient?" [From the Board], December 3 issue).
In my opinion, EHRs are designed to further enslave physicians through pay for performance with its inherent denial of payment, fines, and potential incarceration. Also, the large issue of patient medical record security has not been properly resolved.
We as physicians must separate ourselves from reimbursement of Medicare, Medicaid, and all third-party payers in order to freely practice medicine. I have opted out of Medicare since 2000 and have received no payment from third-party payers for at least 15 years.
RICHARD J. UCCI, MD
Oneonta, New York