My LTE was as follows:
"Accountable care organizations" would backfire
In theory, "accountable care organizations" should encourage physicians to provide cost-effective, "integrated" care. In practice, they will reward physicians for limiting care.
Suppose you see your ACO doctor for a severe headache. He briefly examines you then says, "You don't need a MRI scan of your head; just take two Tylenol and call me in the morning." Can you be completely sure he is acting in your best medical interest? Or might he be unduly influenced by the bonus he receives for reducing the number of MRI scans performed by the ACO?
ACOs make doctors accountable -- but to Medicare bureaucrats, not their patients.
Paul Hsieh, Sedalia