How do Accountable Care Organizations get paid? Medicare has traditionally employed a fee-for-service payment system, where doctors are paid in accordance with the amount of tests and procedures they perform. Many believe this is what drives up costs.
ACOs don’t do away with the Medicare model per se, but they do create incentives by offering bonuses to doctors for keeping costs down and meeting a specific set of care benchmarks. In other words, ACOs ensure doctors are paid more to keep their patients out of the hospital.
The Affordable Care Act – which dictates ACO guidelines – gives regulators the flexibility to devise other payment methods, however, ones that would likely ask ACOs to bear more risk.
Let’s introduce a thought experiment. What happens when you apply an alternative currency, or a currency serving as an alternative to the dominant national/multinational system, to the proposed model? Would patients want to go with physicians in ACOs?
Already a number of uninsured Americans have paid for medical services with some form of alternative currency. Arkansas resident Alisha McNamara found a lump on her lungs this year and tapped into her savings of “Trade Dollars,” issued by regional company Local Trade Partners, to pay for necessary testing.
It’s no surprise – as the US dollar fluctuates, the alternative currency monster has begun rearing its rather attractive head across the country. It may at first sound like a game of Monopoly, but over 30 local communities in the United States have adopted local currencies, a trend that likely grows in popularity.
So what if a few companies, medical practices, or both take up the medical treatment cause and push local healthcare currencies? Just as micro-currencies grow when the larger economy disappoints, ACOs are engineered to cater to the individual, which is why an alternative currency model seems so appropriate here. These kinds of currencies are legal under the US Constitution, provided they look substantially different from and are pegged to the dollar.
In this scenario, the alt-currency model is meant for the patient to bolster the resiliency of ACOs against the precariousness of the American healthcare system. When the economy is tanking, an alternative currency can rise quickly.
Alternative currencies also cater to the hyperlocal, including patients who may be short on dollars but wealthy in resources. Likewise, many ACOs cater to hyperlocal markets as well and this could provide a sense of patient confidence in medical treatment.
And then there’s the sense of pride and exclusivity attached to an alternative currency. This could encourage members of the ACO to continue recruiting members, to buttress the organization’s micro-economic position.
We can daydream about other forms of this, too. Bartering and mutual credit apply, for instance. However, all of this speculation leads to another, perhaps more pressing point: not every alternative currency is taxed, so imagine the kind of taxes a healthcare currency could face.
Do you know what you need when setting up a new medical practice?