AAO-HNS14: Otolaryngologists Recommend Cautious Approach in Transition to Accountable Care Organizations

Most of the cost-cutting attention is being paid to primary care, cardiology, orthopedic surgery, and other specialties, but it benefits otolaryngologists to begin adapting now. Those other specialties “are scrambling and reacting to this. But if we start participating now, we kind of have a quiet luxury of observing, learning, and proactively planning,” Dr. Dillon said. “When the spotlight comes around to us, we’ll be ready.”

Ethical Concerns

Subinoy Das, MD, director of the division of sinus and allergy at the Ohio State University College of Medicine in Columbus, said that the ACO approach to medical care presents ethical problems because it is designed to maximize care to an entire population, not just the individual patient. “We make a covenant to our patient,” Dr. Das said. “There is no command in the Hippocratic Oath for looking out for society or for a larger population.”

Patients who sit on the fringes of the bell curve and have less common illnesses might receive suboptimal care, he said. “That means we’re willing to accept letting some people who are in the minority drop off, or maybe have their health even get worse, if they don’t follow the guideline or they don’t follow the resource allocation that was really geared toward helping all these folks with high blood pressure or diabetes or chronic illnesses,” he said. “Most of our resources then get devoted to people with the most common problems.”

He also said that if it is unethical for a physician to have a financial incentive that might lead to unnecessary care, a potential problem under the fee-for-service model, then it is also unethical for primary care physicians to gain a financial advantage by reducing the amount of care that’s delivered.

He suggested that subscription-based healthcare should be a preferred alternative, that insurance should be high deductible and should extend across state lines to reduce administrative costs, and that individual policies should be tax deductible.

Hope Remains

David Nielsen, MD, executive vice president and CEO of the AAO-HNS, said that there might be a lot of doomsday thinking when it comes to an ACO, but added, “There’s hope for us.”

“The idea that’s rampant is, ‘If I don’t sell my practice to a hospital and become an employed physician and work for a large health plan, I’m doomed. I can’t survive as a one-, two-, three-, four-person group,’” he said. “And that’s simply not true.”