Some may like to look at this issue of the NEJM: http://www.nejm.org/doi/full/10.1056/NEJMp1112293?query=TOC

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http://www.nejm.org/doi/full/10.1056/NEJMp1112293?query=TOC

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The thought has always been that preventative medicine would save costs, yet it has been often shown that this is not always the case because someone always sees the almighty $ in any opportunity. Using diabetes care as an example, preventative medicine in that case added up to more than just dealing with the diabetes in some circumstances. Now, I am one who feels that on an ethical level preventative medicine is simply the right thing to do, as we can help stop and decrease some death and disability. But such as I, and many others see and witness with say "global warming".... oops, climate change, wherein to stop oil drilling we tear mountains apart to get to very rare and precious metals that go into hybrid cars supposedly to save an environment that's just being raped in another way, or clear cut precious habitats and forests in other

countries that do not adhere to rules of the game, we negate what we claimed we were fighting for because someone, even those claiming to do it for the right reasons, find a way to make a profit and can always look the other way or shuttle attention away from what they really do to get to the dollar.Medicine is no different. To achieve "accountability" and to function in a greater team concept such as is proposed in the article, we will actually increase the number of contacts within the system for a single patient, with each stop on the way having their own costs and various entrepreneurs, who in the case of medicine and medicines ancillary groups (such as the pharm companies) have the means to put new ideas to fruition - each carrying with them with the idea they deserve to make a profit from their endeavors - so we thus create a new committee, a new case management system, we add new call centers, we assign new categories

and create new positions to meet new needs such as "following up 7 days after discharge" and so on. Each one increases costs.Still, this "accountability" is nothing new as a proposal - as this is what is always talked about year after year in some healthcare context. Having every aspect of a patients care micromanaged is a wonderful idea in a perfect world. Sadly the almighty dollar rules and as we would try this in a coordinated fashion, we would introduce more agencies and likely create more positions and contacts for the patient, which in turn means to each one deserves a good pay, which in turn means costs go up (I realize the counter argument is in the long run it would reduce costs - but sad experience says each new opportunity in medicine tends to drive it up due to the reasons I mentioned).And do we even have to go over what happens when a patient's

care keeps driving costs up? Insurance rates jump, committees or panels now have to decide which care someone "deserves", hospitals, clinics, universities, make cuts and have layoffs, and so on down the road. Again ethically it is exactly what people should get. But economically and practically we know from experience that the right thing to do only lasts as long as the money does. That's my take on it. Would be nice, but would never last in our focus on economics and the desire to each get his or her piece of the proverbial pie. Subject: Some may like to look at this issue of the NEJM:

http://www.nejm.org/doi/full/10.1056/NEJMp1112293?query=TOCTo: hyperaldosteronism Cc: "Grim Clarence" Date: Saturday, December 31, 2011, 12:24 AM

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I was in an HMO once that used " PODs " Everyone with Pacificare could only go to docs in their pods, and each pod was controlled by an IPA (individual practice association). The pod got $xx/month per enrollee. At the end of each month, profits were divided up among the IPA participants. They made their money by withholding care. Unfortunately, I got very sick with hyperparathyroidism while I was in Pacificare. I went to five primary docs in, each one telling me my insurance wouldn't allow the surgery. Every time I called Pacificare, I was told they were not denying it. Then the doc would fire me. I got fired several times until I threatened legal action against Pacificare. They finally let me go to a doc outside my IPA and I got surgery at a much better hospital than was available in my POD. However, good deeds never go unpunished. Many others complained as well. My husband was the CFO of a 3,000+ employee organization. Pacificare lost that contract, and Pacificare is no longer. ACOs sound like glorified PODS or HMOs. They will not go over well if people are told where they can go to see a physician. I'd sooner die than ever again be part of an HMO. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: Friday, December 30, 2011 11:25 PMTo: hyperaldosteronism Cc: Grim ClarenceSubject: Some may like to look at this issue of the NEJM: http://www.nejm.org/doi/full/10.1056/NEJMp1112293?query=TOC

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Sounds like the old FHP of California....who we called Fatal Health PlanSent from my Palm Pre on the Now Network from Sprint

I was in an HMO once that used "PODs" Everyone with Pacificare could only go to docs in their pods, and each pod was controlled by an IPA (individual practice association). The pod got $xx/month per enrollee. At the end of each month, profits were divided up among the IPA participants. They made their money by withholding care. Unfortunately, I got very sick with hyperparathyroidism while I was in Pacificare. I went to five primary docs in, each one telling me my insurance wouldn't allow the surgery. Every time I called Pacificare, I was told they were not denying it. Then the doc would fire me. I got fired several times until I threatened legal action against Pacificare. They finally let me go to a doc outside my IPA and I got surgery at a much better hospital than was available in my POD. However, good deeds never go unpunished. Many others complained as well. My husband was the CFO of a 3,000+ employee organization. Pacificare lost that contract, and Pacificare is no longer. ACOs sound like glorified PODS or HMOs. They will not go over well if people are told where they can go to see a physician. I'd sooner die than ever again be part of an HMO. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: Friday, December 30, 2011 11:25 PMTo: hyperaldosteronism Cc: Grim ClarenceSubject: Some may like to look at this issue of the NEJM: http://www.nejm.org/doi/full/10.1056/NEJMp1112293?query=TOC