In Healthcare it Takes a Village — But What Kind of Village Will it Be?

As the country’s healthcare providers increasingly form Accountable Care Organizations to share resources and responsibilities for treating Medicare patients, the Southern Medical Association says it takes a village to provide good healthcare, and that the ACO model is that village.

It’s very true that healthcare delivery is a group effort. When a multidisciplinary approach is used to tackle problems of human health, patient outcomes will improve.

But is this village the SMA describes just be for patients who are treated by large health systems, or will it be a diverse enough village to include patients who visit independent doctors? And will there be freedom of choice in this village, or will all the important decisions be dictated from above?

If our healthcare system is going to be truly inclusive and democratic as we move to the ACO model, then the survival of independent doctors is more important today than ever before.

Independent medical practices have been gradually vanishing because cost pressures and administrative and regulatory burdens. Many physicians find it easier to join a larger health network than to face these challenges with limited resources. The loss of these practices takes away healthcare access for many patients in underserved parts of the country, and reduces the number of treatment options in the overall healthcare system.

Doctors who are part of managed care have been combining resources and sharing the responsibility of implementing Medicare programs, and networks of independent doctors are joining in this restructuring of healthcare delivery in America. But if these independent practitioners continue to close their doors, the number of patients who can benefit from the “village” of healthcare providers cited by SMA will get smaller. That’s not the direction we should be moving in.

Additionally, if every doctor and healthcare administrator in the village is a part of the managed-care system, it means that every treatment decision for every patient will be — to some extent — dictated from a small group of people at the top. Managing healthcare for large populations of patients means there must be strict protocols for the delivery of healthcare.

While these protocols are important, and while they are determined by dedicated healthcare providers, they can never guarantee the best treatment course for all patients all of the time. There is no “one-size-fits-all” in healthcare.

Independent doctors and medical clinics represent more choice, and they represent independent treatment decisions.

Many patients in America live in areas that are not adequately covered by the larger health systems, including inner cities and rural areas. Under the current ACO model, too many of these patients will be left out of the village.

And too many of the patients who are included in the village will have important treatment decisions dictated by policies that were not written by their own doctor, but by the leaders of the village. These leaders have the best intentions, but they are removed from the day-to-day diagnosis and treatment of individual patients.

This is just one more reason why America cannot lose its independent doctors. We should be building products that will not only help these doctors flourish, but will connect them to the larger health systems and government agencies that are crucial in healthcare delivery.

The survival of independent medical practices is the key to making sure the village includes everyone, and that doctors and patients truly will have freedom of choice.

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