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Industry insiders have watched accountable care organizations (ACOs) thrive at the expense of smaller practices—including more than a few urgent care centers. Now one of the architects of the Affordable Care Act (ACA, also known as “Obamacare”), which laid the foundation for the ACOs, is having second thoughts. Bob Kocher, MD, who as a special assistant to President Obama helped shape the ACA, writes in a Wall Street Journal op-ed piece that in spite of predictions that consolidation among healthcare giants would be good for the system and patients alike, “smaller practices have improved care better.” Kocher and other ACA designers thought that economies of scale favored large organizations when it came to improving cost and access. “What I know now, though, is that having every provider in healthcare ‘owned’ by a single organization is more likely to be a barrier to better care,” Kocher writes. “Small, independent practices know their patients better than any large health system ever can. They…are driven to innovate. [They] can learn faster.” He points to adoption of electronic health records technology as an example of how “smaller” equated to “easier” in recent history. The solution, Kocher concludes, is for the federal government to recognize “the strength in the small practices [and] write rules that make it easier for them to thrive under Obama Care…. Personal relationships of the kind often found in smaller practices are the key to the practice of medicine.”

Oops! ACA Architect Says Small Practices Make ‘Better’ Improvements Than ACOs
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