Published January 30, 2013
A video leaked to FOX Business mocks how health reform can make more money for doctors and hospitals by preventing patients from being readmitted to hospitals.
The video, made by Morristown Medical Center in Morristown, N.J., a member of the Atlantic Health System, is meant to recruit doctors and medical staffers to join health reform’s new “Accountable Care Organizations,” (ACOs), key to cost savings in the health-reform law.
The video shows doctors barring the doors (See video below article) of the hospital to stop patients from being readmitted for more care, dollar bills exchanging hands between doctors and staffers, as well as workers getting free stuff like laptops.
In the video, a musician sings lyrics to the tune of Waylon Jennings’ “Looking for Love”: “Building an ACO for all the right reasons, an ACO decreasing readmissions.”
The song continues: “Sharing these savings with practices sure seems fair, long as we follow the policies set down by Medicare,” as the video shows money changing hands.
The singer also sings: “Improving care, no more gaps or omissions, what CMS is dreaming of,” as the top executive of the hospital pretends to sleep on the couch. CMS stands for the federal government’s Centers for Medicare & Medicaid Services.
A hospital spokesman tells FOX Business: “The ACO video lyrics came from the ACO Atlantic Health System. I don’t believe the video was meant as a spoof or a mockery by any means. It’s a fun spoof, preventing readmissions as you saw. It’s certainly not meant as a mockery, it’s a video showing the benefits of ACOs. It’s about working together, partnership, taking better care of patients.”
But a staff doctor notes: “The less number of patients re-admitted, or the less exams or tests or referrals, the more government money there is in the pot for the ACO and the more bonuses for the doctors. The less you do as a doctor, the more money the ACO makes. The less risky patients with complications you take on, the more money the ACO makes, because risky patients are going to cost the hospital more money to treat them. That’s why they’re exchanging money in the video. If I order less tests, I get a bonus. If I join, I get free stuff, like free laptops. An ACO pockets more government money by instead making patients manage their illness at home.”
Health reform’s ACOs are meant to curtail soaring health costs from too many doctors ordering too many tests for Medicare patients. But despite the White House’s exhortations that health reform will provide more care, ACOs put the country on a path towards less care, doctors tell FOX Business.
ACOs are partnerships of medical providers — doctors, specialists, clinics and hospitals — that operate on a set budget. They get Medicare or Medicaid money from the federal government every year.
Budgets are set according to the health of the population the ACO serves, with payments tied to federal quality standards. Hospitals can earn higher profits and doctors can get bonuses in exchange for meeting federal quality and cost controls, including limiting hospital readmissions. If costs exceed the budget, ACOs share in the losses.
“ACOs reward doctors and medical workers for providing less care to patients,” says a Morristown Medical staffer. ”They reward bad doctors and punish good doctors. If someone dies, it’s more cost effective and cheaper. If someone is readmitted for, say, a wound not healing, the hospital doesn’t get paid by Medicaid or Medicare, it gets fined. Wheeling and dealing is bad care for patients. It is the patient who will get screwed. An ACO is mechanical care, it turns doctors into 9-to-5 shift workers.”
A doctor at the hospital also tells FBN: “Health reform, though, was meant to increase access to health care. Instead, ACOs decrease access to care. It’s totally opposite of what the President wants. ACOs also erode the doctor-patient bond.”
The video surfaces as the federal government recently approved 106 new ACOs. The U.S. Department of Health and Human Services says that as of last July, Medicare ACOs were serving 2.4 million people in 40 states and D.C.
There is cold math behind health reform’s ACOs, now the new face of medicine. At about $550 billion, Medicare is the third largest budget item in the federal government, behind Social Security and defense, and is set to outstrip defense spending in about two years.
But an avalanche of baby boomers retiring, a looming doctor shortage, and hospital bed shortages have given rise to ACOs. Doctors and medical workers warn that baby boomers will increasingly not be treated in hospitals, but in their homes or even over the phone, and not by doctors, but by physician assistants or nurses.
To be sure, many patients would argue that hospitals are vast reservoirs of bacteria and viruses, and would rather avoid them. “But if you get an illness at home after you leave the hospital and really do need more hospital care, an ACO may bargain with you to not re-admit you,” a doctor warns.
Another element of health reform is driving doctors to join ACOs. Central to health reform are “electronic medical records systems, which must be put in place to process Medicare and Medicaid patients,” a doctor explains. “But doctors can’t afford them, so they join an ACO,”
Dr. Jeff Goldsmith PhD, president of Health Futures Inc. and associate professor of Public Health Sciences at the University of Virginia, warned in a 2009 column about a dramatic culture shift in health care. “A rapidly increasing percentage of physicians, particularly primary care physicians, are now hospital employees,” he wrote.
The doctor added: “An entire generation of 80-hour-a-week baby-boomer physicians are retiring and being replaced by younger physicians who want to work 30 hours a week.”
Dr. Goldsmith also warned: “Hospitals will become ‘collections’ of physicians, not communities” with profit and loss statements and management “infrastructure.”
However, ACOs could soon be used for Medicaid, too. The 2010 health-reform bill authorizes a demonstration project that would launch pediatric ACOs within Medicaid and the State Children’s Health Insurance programs. To date, funding is not yet available, sources and reports indicate.