Doctors are sending letters to their patients informing them that the doctor’s practice is participating in a Medicare Accountable Care Organization (ACO). The ACOs are a new feature of Medicare that aims to get doctors, hospitals and health care providers to work together to better coordinate a patient’s care. One such letter states, “By helping your doctors and primary care providers to communicate more closely with your other health care providers, ACOs can deliver high quality, more coordinated care that meets your individual needs and preferences.” In addition to the care coordination, another lure for doctors and providers is “shared savings” they will achieve if they succeed in lowering health care costs for their patients.
The purpose of letters sent out to patients is to get them to approve sharing of information. A letter sent out from a North Country doctor participating in HealthCare Partners of the North Country, asked the patient to allow doctors to share the patient’s medical records with Medicare and other doctors participating in the ACO. The patient can refuse to do so. The heading on the letter says: “Notice to Patients: Your Provider is Participating in a Medicare Shared Savings Program Accountable Care Organization.”
The letter stresses that the ACO is not a Medicare Advantage Plan and that “your Medicare benefits aren’t changing… You still have the right to use any doctor or hospital that accepts Medicare at any time.” Medicare will automatically share information with doctors participating in the ACO unless the patient affirmatively opts out and does not want the information shared by either contacting the doctor or Medicare. To opt out at the doctor’s office, the patient needs to sign a form called “Declining to Share Personal Health Information.”
Medicare recently announced that it is planning to move away from the fee for service payment model and have most payments be based on coordinated care in the future. It will be important for consumer and patients advocates to monitor how this is working to see if care is better coordinated. This is a very difficult situation for patients. Doctors may decide that certain tests and procedures are not needed or are ineffective and that may be appropriate to not authorize them. However, denials also will produce financial benefits for doctors and providers and conflicts might arise if patients feel they have a problem and want a test and it isn’t authorized.
We will need to follow this and see what the studies and personal experience shows about how ACOs are operating. Ideally, by sharing information with other providers and making sure to follow up with patients when they go home from the hospital, overall care should be better. If doctors practices decide to hire additional staff to check in on patients with chronic conditions or those who have left the hospital recently that will be a great benefit. It only makes sense and should have been happening anyway.