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Tuesday, March 01, 2011

Getting Over It

The left-leaning, policy guru elite of health care have never been very fond of hospitals, which are seen as a bureaucratic, financially-oriented part of the corporate world. Under the control of the bankers, lawyers and industrialists who populate their governing boards, they have the image of catering more to wealthy donors and affluent doctors than to the common and needy people of the community.

So it comes as no surprise that there is a pervasive reluctance to recognize hospitals as the prime candidates to assume the role of Accountable Care Organization (ACO). An ACO is a legal entity that incorporates the basic elements of health care, including the physician and hospital components, and is able to provide all the care a patient needs for a fixed sum of money, the amount of which is determined in advance.

There is much vague speculation about the corporate nature of an ACO – whether a physician group might qualify, whether “virtual organizations” might be created to play the role, whether insurance companies could do it, etc. etc.

All of this ignores the reality that hospitals are by a wide margin the best qualified to be ACOs and that many of them would be able to do so with few legal and organizational changes. They have the financial capital and administrative structure needed. The number of physicians they employ or otherwise relate to on a full-time basis is large and increasing. In their pursuit of safety and improved outcomes, they are steadily gaining experience in designing and implementing the kind of clinical management for which ACOs are intended.

So to those who are hesitant to assign the ACO role to hospitals, I have three words of advice:

Get over it.

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