The Relationship between the VA Scandal, Meaningful Use & ACOs

We’ve all heard and talked about the various reasons for the mess that the VA health care system has become. While I never worked in a VA Medical Center, I have the privilege of caring for many veterans in my practice. Here I wish to connect the dots of how main-stream health care is going the way of the VA system, and suggest simple but effective ways to prevent that from happening.

We in the medical community have been sold this idea that we can get “bonus” payments from Medicare & Medicaid for documenting “Meaningful Use” of Electronic Medical Records (EMR’s).  This behavior has been further codified into law with the ObamaCare-created Accountable Care Organizations (ACOs).  ACOs purportedly bring all health care providers together to collect bonus payments (again from Medicare) for providing “proof” via “metrics” that we are providing “evidence-based” and “high quality, cost-effective” care to populations that Medicare assigns to our ACO.

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What a wonderful idea…except that it’s not true in the real world. The real reason for the VA disaster is directly related to officials demonstrating “high quality metrics” that the government demands (and getting bonus payments for such demonstration) while not being able to actually provide the service in real life. In other words, a neat cover to a lousy book. Looking at non-VA medical care, all the documentation of “high quality metrics” via either Meaningful Use of an EMR or via an ACO, will be of similar value as did the metrics submitted by VA officials.

The real solution comes from pursuing a philosophy of the Hippocratic Physician…i.e. caring for each patient as an individual, and letting each patient decide the value of the care he/she receives. The VA story solidifies my conviction that we need to abandon the mythical ideas of “metrics” and “evidence-based” being the end-all for determining “quality-based” payments to all medical providers. It is time for Congress to pass a law ending Meaningful Use and ACOs. Instead, if each one of us (including hospitals, nursing homes, pharmacies, etc.) took it upon ourselves to provide the best individualized care to every patient, with real patient choice driving us all to provide better care, then we will achieve the goal of high quality, patient-centric care. And, by the way, we can do the same for our veterans, in our communities, without forcing them to seek care at VA medical centers only. We owe this to them.


Arvind Cavale MD is an endocrinologist in private practice, you can follow Dr. Cavale on Twitter @endodocPA.

Photo by ** RCB **

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