New Risks Posed by Accountable Care Organizations

December 31, 2010 (Press-News.org) When Congress passed the health care law earlier this year, one of the goals was to foster cooperation within the currently fragmented health care system. In theory, by encouraging medical professionals to cooperate and take joint responsibility for the costs and quality of patient care and providing incentives for this cooperation, the costs of medical care should go down while the quality rises.

Across the country, hospitals, clinics and doctors are joining forces through new entities known as accountable care organizations, eager to reap the benefits of the newly-established incentives. With this development, experts say that patients may benefit from having a coordinated network of care providers. When these organizations are successful in limiting patient costs, they have the potential to earn bonuses.

Although the law is well intentioned, consumer advocates fear it could actually have the opposite effect, reducing competition and driving up costs. With fewer competitors, patient care is likely to suffer, because the patients simply have fewer options. One expert on health and antitrust law warns that the risk that dominant providers and insurers may jointly or individually exert their market power has never been greater than it is now.

In fact, industry groups are already lobbying for relaxation of federal antitrust, Medicare and health care billing laws. The American Medical Association is requesting an explicit exception to the antitrust laws for doctors who participate in the new entities.

Judith A. Stein, director of the nonprofit Center for Medicare Advocacy, has voiced concern that health care organizations may try to hold down costs by accepting only healthier patients and by denying even necessary care. Although this may allow organizations to meet their targets, it does not ultimately protect the patients seeking care.

A lawyer for the Consortium for Citizens with Disabilities echoes Stein's concerns, saying that those with disabilities, chronic conditions or those who require specialized care need to worry in an environment that financially rewards providers for keeping down costs.

It is not yet possible to understand the full effects of the new law, but the potential for reducing the quality of patient care warrants further investigation. When costs and profits are put before the best interests of a patient, there is legitimate cause for concern.

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