I received a letter from my Accountable Care Organization (ACO) in February, which offered me the choice of sharing my medical information with them or not. My first reactions were, “What is an ACO?” and “How was I enrolled without my knowledge.”

As I learned later, ACOs are entities authorized by the federal government under the Affordable Care Act, or “Obamacare,” to monitor medical expenses of Medicare patients. There is more than one ACO in Michiana. My ACO operates in the St. Joseph Hospital system but does not currently have a relationship with Memorial Hospital. ACO goals are to eliminate redundant tests and treatments and to help patients avoid being readmitted to hospitals soon after being discharged. When my general practitioner joined this ACO, all his patients were automatically and involuntarily enrolled. My only option is not to authorize the ACO to share my Medicare information with others.

Intrigued that I was involuntarily enrolled, I called the ACO customer assistance number. A nice person explained the above information and invited me to a workshop where the ACO would be discussed in detail. My wife and I went. There representatives from my specific ACO described many positive aspects of ACO organizations. These include home visits after hospital stays for follow-up with patients. ACO could eliminate redundant tests by crosschecking of medical billing records from multiple doctors. I have not included an exhaustive list of positive aspects. Everybody was nodding their heads positively.

Then came the question and answer period.

The ACO representatives revealed that the ACO has eight medical managers for 14,000 Medicare patients.

Eyebrows went up.

The ACO representatives had no convincing answer for how to deal with the delay in medical billing. For instance I get some medical bills two or three months after treatment.

Eyebrows went up a little higher. If my general practitioner participates with one ACO and I get treatment from a doctor or clinic that does not, how can my ACO manage all my medical treatment? My wife inquired about the security of ACO operations. That is, how well is the privacy of our electronic medical information secured by the ACO? I didn’t understand the answer.

I asked how were ACOs financed and what did the word “accountable” in ACO imply–accountable to whom? ACOs receive money from Medicare if they reduce Medicare expenses by reducing unnecessary hospitalizations or redundant treatments. We were told, “Accountable means that the ACOs are accountable to Medicare patients.” Some people in the audience including myself began to frown.

I’m a natural skeptic. How can an ACO be accountable to Medicare patients if the ACO’s income stream depends on reducing Medicare expenses? Is there a danger of hacking medical information stored in ACOs? How can eight managers manage the medical treatment of 14,000 Medicare patients? How can an ACO catch redundant tests or treatments if it must wait for Medicare billing? Will this portion of Obamacare function any better than the Obamacare enrollment website? Maybe.

This is part of Obamacare; what could go wrong?

 

Michael Waldron is a retired lieutenant colonel, US Army, who was born and raised in Niles. He has served on the Niles Community School Board of Education since 2007. He can be reached at ml.waldron61@gmail.com.