‘Gatekeepers’ Can Be Culpable

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In the case of Warren v. Dinter, the Minnesota Supreme Court ruled that a physician acting on behalf of an Obamacare Accountable Care Organization (ACO) can be held culpable for the “reasonably foreseeable” result of “not opening the gate,” reports Robert W. Geist, M.D., a retired physician residing in Minnesota, in the fall issue of the Journal of American Physicians and Surgeons.  When a patient died of sepsis after being denied hospital admission, both the nurse practitioner who saw her, and the hospitalist who advised sending her home based on a telephone call, were sued for malpractice.

Read Journal Article: https://jpands.org/vol24no3/geist.pdf

“ACOs are profit-driven mini-insurance corporations without a license, practicing medicine without a license,” Dr. Geist writes. ACOs are intended to achieve savings to be shared with the Centers for Medicare and Medicaid services (CMS), made possible by waivers of specific fraud and abuse laws, including the physician self-referral law and the federal Anti-Kickback Statute.

ACOs are an intended cure for the recurrence of unrelenting cost-price inflation that began abruptly after 1965, following passage of the Medicare and Medicaid laws. But they have resulted in “an insurance game of profiteering through gainsharing kickbacks at the bedside,” Dr. Geist explains. “The incentive system puts clinicians in an “impossible bind between demands for frugality and demands for excellence.”

The Minnesota decision “may help to protect patients from gatekeepers denying care for a patient who was not been seen by a physician,” Dr. Geist states. But “further remedies would be wise,” because “ACO mercenary budget-balancing through profiteering kickbacks to clinicians incentivized to ration care is protected by federal waivers of patient-protection laws.”

“Most patients are safe today, because the vast majority of medical workers honor their patient loyalty covenant. This can change tomorrow, as collusive corporations financially coerce corporate loyalty,” Dr Geist warns.

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.