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Tuesday, June 7, 2011

What are Accountable-care Organizations and how do We Avoid them

According to AVERY JOHNSON  of the The Wall Street Journal in New York
In broad outline, these entities propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO's bottom line”

“ACOs exist more on paper than in reality, for now. But a few organizations up and running for decades do closely resemble how the concept can work. One of the most prominent is Atrius Health of Newton, Mass., an alliance of five medical groups comprising more than 800 physicians, about 700,000 patients and 30-plus care centers in eastern Massachusetts.”

This is the State that has Rommycare and they are having all kinds of problems with it.  What it really is, is more Health Care Delivery. not quality Health Care, where someone else is making medical decisions for you instead of you making them for yourself and your family.  Guess who will be making those decisions for you and your family?  A panel of 15 People that are appointed as government appointees. Is this what we want to hear?  No, enough with the government, insurance companies, AMA, and the drug companies making our decisions!

According to an article by ANNA WILDE MATHEWS  for the Wall Street Journal Hospitals and Doctors are pushing back against this as well.  Click Here for the complete Article.

“Hospitals and doctors are pushing back against an Obama administration initiative that urges them to create new organizations to coordinate the care of groups of Medicare patients.
The voluntary program seeks to save money and improve treatment. But the health-care providers say the rules proposed for the initiative are too onerous and the financial incentives too weak, and that they will participate only if the program gets a major revamp.
The deadline for response to the proposal is June 6, but health-care providers have already been unusually vocal in their complaints. "It's pretty much a nonstarter as structured," said Anders M. Gilberg, an official at the Medical Group Management Association.”

Obamacare is what is driving this program.  If you look at it, it will only lead to rationed care for people on Medicare.  Obamacare came from the same people who now run commercials showing a Congressman throwing Granny off a cliff.  Well, who is really throwing Granny off the cliff?

Until we, as Americans, step up and take responsibility for our health care, this problem will never be solved.


Step Number One:  Change your mindset that someone else is going to pay for your health care.
Step Number Two:   Start paying cash for your doctor visits.

The best way to buy anything is to buy it direct.  We buy our cars, food, and just about everything else directly so why should Medical Care be any different?  Because we have been told for more than 50 years that we have to have medical insurance to get medical care.  Number one, this is a lie; if you need medical care and go to the emergency room, they have to treat you to the best of their ability, regardless of your ability to pay.  I am not saying this is what you should do if you can pay but I am saying that you do not have to have insurance to get medical care.

A medical care delivery system is not medical care.  We don’t buy car insurance to cover the cost of gas, oil changes, tires, and the minor repairs.  We buy it to pay for the major problems, i.e., if we have a wreck.  Yet we buy health care insurance so we can go to a doctor’s office and pay a $25 to $35 co-pay and pay hundreds of dollars a month for this privilege.  Does this make sense to you?  It doesn’t to me! 

I know you are asking, “How can I pay cash to go to the doctor when an office visit might cost $110 to $140 for a visit?”  You don’t have to do that either.  You can negotiate with your doctor for a discounted cash rate or you can become a member in a PPO directly.  Remember, insurance companies have been using PPO Rates for 50 years or more, so why should you not be able to do the same thing?  I am not talking about a medical discount program, I am talking about a true Medical Savings program.  One such program is Direct Concepts Healthcare  which puts you into two of the largest PPO’s in the country;  PHCS and Galaxy Networks.  This includes Doctors, Hospitals, and all the service’s, i.e., labs, x-ray’s, MRI’s, etc.  It also has a prescription discount program that will save you 10% to 80%.  It also includes Dental, Vision, and Alternative Health Care, plus more.  All for $88 per month, per family, with no restrictions for pre-existing conditions.  There is also an Rx program for FDA approved, name brand Prescriptions, based on family income for $20 per month, per prescription.  This is a separate program and you do not have to be in the $88 program to join it.

By paying the PPO rate, you are getting the same rate that the insurance companies pay the doctor; the difference is the doctor gets the full  PPO payment at the time of your visit.  He doesn’t have to file insurance papers and wait to get his money from the insurance company. Which, by the way, will be the PPO Allowable, not his cash price. And you are not paying an insurance company hundreds of dollars a month.  It also gives you and your Doctor control over your treatment without the government or insurance company telling him what treatments he can and can’t give you or your family.

It is up to YOU to decide if you are going to control your health care are let the government, Insurance companies, or someone else decide your health care future.

Stay tuned for the next update.  I hope I am helping you to become informed  about what is going on in the Health care industry and a way to protect you and your family.  Be sure to sign up to get regular updates by Subscribing via email on the right hand side of our blog.

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