Updated: Aug 6
As the country's healthcare providers increasingly form Accountable Care Organizations to share resources and responsibilities for treating Medicare patients, the Southern Medical Association says it takes a village to provide good Healthcare and that the ACO model is that village.
It's very accurate that healthcare delivery is a group effort. Patient outcomes will improve when a multidisciplinary approach is used to tackle human health problems.
But is this village the SMA describes for patients treated by large health systems, or will it be a diverse enough town to include patients who visit independent doctors?
Will, there be freedom of choice in this village?- or will all the critical decisions be dictated from above?
Suppose our healthcare system is truly inclusive and democratic as we move to the ACO model. In that case, the survival of independent doctors is more important today than ever.
Independent medical practices have been gradually vanishing because of cost pressures and administrative and regulatory burdens. Many physicians find joining an extensive health network easier than facing these challenges with limited resources. The loss of these practices takes away healthcare access for many patients in underserved parts of the country and reduces the number of treatment options in the healthcare system.
Doctors part of managed care have been combining resources and sharing the responsibility of implementing Medicare programs. Networks of independent doctors are joining in this restructuring of healthcare delivery in America. But if these independent practitioners continue to close their doors, the number of patients who can benefit from the "village" of healthcare providers cited by SMA will get smaller. That's not the direction we should be moving in.
Additionally, suppose every doctor and healthcare administrator in the village is a part of the managed-care system. In that case, every treatment decision for every patient will be — to some extent — dictated by a small group of people at the top. Managing Healthcare for large populations of patients means there must be strict protocols for delivering Healthcare.
While these protocols are essential, and while dedicated healthcare providers determine them, they can never guarantee the best treatment course for all patients all the time. There is no "one-size-fits-all" in Healthcare.
Independent doctors and medical clinics represent more choice and independent treatment decisions.
Many patients in America live in areas not adequately covered by the larger health systems, including inner cities and rural areas. Under the current ACO model, too many patients will be left out of the village.
And too many of the patients in the village will have important treatment decisions dictated by policies that their doctor did not write but by the village's leaders. These leaders have the best intentions but are removed from the day-to-day diagnosis and treatment of individual patients. That is one more reason America cannot lose its independent doctors. We should build products to help these doctors flourish and connect them to the larger health systems and government agencies crucial in healthcare delivery.
The survival of independent medical practices is the key to ensuring the village includes everyone and that doctors and patients have freedom of choice.