ACO model’s outcomes far from certain

PUTNEY — Retiring Gov. Peter Shumlin and his outgoing administration promoted “all-inclusive population-based payment” for hospital and medical diagnosis, care, and treatment during recent public forums about the Vermont All-Payer Accountable Care Organization (ACO) Model.

They did not say how much this all-inclusive payment will cost.

I asked at the Rutland forum and learned that it will cost $4,960 annually per commercially insured patient and $8,165 annually per Medicare patient.

They also did not say that “capitation, now referred to as all-inclusive population-based payment, will be one of four available payment mechanisms from which the ACO will select” (according to the U.S. Centers for Medicare & Medicaid Services).

Capitation is “a health-care system in which a medical provider is given a set fee per patient (as an HMO) regardless of treatment required” - and provided (Merriam-Webster's Collegiate Dictionary).

“Although many capitated arrangements of the 1990s proved unpopular with much of the public, and sometimes disastrous for physicians, some believe that this time will be different,” according to the American Medical Association's website.

Some patients - increasingly, aging baby boomers - will need more health care than others.

Then there are outliers through no fault of their own: Saving my middle-aged friend's life after a catastrophic needle biopsy cost those who are commercially insured $3 million - equivalent to capitated annual payments for 600 patients. Worthwhile? She's very much alive years afterward.

So I asked how rationing of health care will be avoided. By spreading risks among insurers via reinsurance, we were told. But how many insurers are there in Vermont?

Should health-care costs be controlled experimentally by an outgoing governor and administration who will not be accountable to Vermonters for the uncertain outcome?

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