The incentives for physicians and hospital to control costs under the accountable care organization model present potential for abuse, according to an official cited in the report. Although Medicare can penalize organizations that avoid high-risk, high-cost patients, consumers are still concerned that organizations may try to maintain low costs by “cherry-picking healthier patients and denying care when needed,” according to Judith A. Stein, director of the non-profit Center for Medicare Advocacy, who was cited in the report. This is especially of concern for individuals with disabilities or chronic conditions.
Other consumers fear that ACOS and healthcare consolidation may lead to higher prices by making organizations more powerful with “commensurate ability to raise prices,” according to Elizabeth B. Gilbertson, chief strategist of a union health plan for hotel and restaurant employees, who was cited in the report.
Other consumer concerns arise from healthcare organizations urging federal officials to provide explicit exception to antitrust laws for doctors participating in ACOs. Hospitals and doctors have also asked federal officials to waive laws intended to prevent Medicare fraud and abuse, calling them “barriers” to ACO creation, according to the report.
Read the New York Times report on healthcare mergers and consolidation.
Read more about mergers and ACOs:
–Healthcare Reform Paving Way for More and Different Hospital Merger & Acquisition Activity
–Study: Hospital Mergers Lead to Higher Costs
–7 Thoughts on How Antitrust Laws Could be Changed to Accommodate ACOs
