Friday, October 8, 2010

The Prism of Ethics: Was This Change to Medicare Part of the Plan?

In preparation for a talk about Health Care Reform that I am scheduled to give to the West Valley Bar
Association, later this month, I have been going through the Patient Protection and Affordable CareAct [the "ACA"] page by page, line by line and word by word.

At page 271 of the AFA, PART III is entitled "Encouraging Development of New Patient Care Models" which seems benign enough. But as I moved along to page 277, I came upon Section 3022 "MEDICARE SHARED SAVINGS PROGRAM" which describes "Accountable Care Organizations" (ACOs), groups of providersd who may "work together to manage and coordinate care for Medicare fee-for-service beneficiaries through an accountable care organization." Sounds benign enough.  But then I read on.

At page 279 there was this language:  "(c) ASSIGNMENT OF MEDICARE FEE-FOR-SERVICE BENEFICIARIES TO ACOs.-The Secretary shall determine an appropriate method to assign Medicare fee-for-service beneficiaries to an ACO based on their utilization of primary care services provided under this title by an ACO professional described in subsection (h)(1)(A). (Underlining supplied)  Just a moment - I thought that under fee-for-service Medicare, patients chose their own doctors, but this section appears to take away that choice in the interest of a Medicare Savings Program study.  And then, I found this section at page 280:

"(g") LIMITATIONS ON REVIEW.-There shall be no administrative or judicial review under section 1869, section 1878 or otherwise of -
"(1) the specification of criteria under subsection (a)(1)(B);
"(2) the assessment of the quality of care furnished by an ACO and the establishment of performance standards under subsection (b)(3);
"(3) the assignment of Medicare fee-for-service beneficiaries to an ACO under subsection (c) (underlined supplied) . . . . .

So, some Medicare fee-for-service beneficiaries may be plucked out of their chosen physicians' offices and reassigned to an "ACO" with no right of appeal?  Is my reading correct?

Gee, did President Obama, or the people pushing this "reform" bill through Congress mention that to the people potentially affected?

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