Thus far any threat to physicain income imposed by the government has been countered by physicians adding new office-based services, raising their rates, DROPPING OUT OF MEDICARE AND MEDICAID, and demanding payment for ED call and medical diretorships from the hospital.

This is REALITY from my boots being on the ground negotiating face to face with physicians day in and day out – in 85 markets per year… if Aaron McKethan and Mark McClellan believe that they can convince most physicians to join an ACO –then they are better negotiators than i — and i would welcome them joining my firm anytime –

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My physicians’ raison d’être is to care for patients and I know that they went to many years of grueling education, residency and fellowship and the critique of their peers to accept the responsibilities that accompany the privilege to care for me. I want to believe that every time they cut skin or prescribe a medication that could save me or risk my life I want them focused on me as a patient, not kowtowing to some element of a formula to justify paying them for their service.

Be that as it may, this new theory continues the misconception that somehow the only sources for high cost and poor outcomes in medicine is due to the faults of the “providers”. It will only take the authors a few minute to review the extensive research available that shows that patient-related factors play a more significant role in escalating costs and towards poor outcomes.

Nothing in the ACO model or any model that does not address this major problem will ever come close to the stated objectives. We know that chronic diseases are responsible for a big chunk of health care costs. Unless personal responsibility on the part of patients is stressed and incentivized/disincentivized, we cannot make headway into reducing costs or improving outcomes in chronic diseases.

Finally, a thought that I would like the authors to consider – why do you feel it is improper for physicians as professionals to expect fair reimbursement for legitimate services provided? Could you give me examples where other professionals are forced to do this? Do we pay our investment planners less because our portfolio lost 40% value since last year? Is a ball player’s salary cut at the end of a season if his batting average is poor this year? Why is everybody so afraid to let the marketplace place an appropriate value to each physician’s service? Why are we scared to ask our patients which service is of value to them? Why do government and ivory tower academics think they know what’s good for the average patient/consumer?

Let’s try simplicity for a change and see how it works. We can give you guys some sort of award for your dissertation, but just leave us docs and patients alone, so that we can decide what works best for each individual, rather than trying to figure out a complicated formula.