Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What does an ACO mean in small town America?

Robert Provenzano, MD
Policy
June 9, 2012
Share
Tweet
Share

At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations.

The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the hustle and bustle and almost fleeting nature of medicine in the fast-paced world of big-city hospitals, where hyper- competitiveness often rules at the expense of quality. Why not? Patients, patient outcomes, mortality, complications etc. are consolidated, collated and analyzed; nameless and faceless. They are discussed at the weekly “safety” meeting or the monthly quality meeting structured to “hit our numbers,” meet our risk-contract goals. Sometimes, if you don’t force yourself to stand back and remember that statistics are tools to help guide us and that actual patient care is rendered “eyeball-to-eyeball,” one on one, you can get lost, lose your focus—your purpose.

In Nampa there was permanence; I could see it, feel it, the physicians exuded it. They were there for the long haul, comfortable in their own skins; they were there for their communities. They were there for each other and there for their patients. Outcomes? Quality? Their “numbers”? All had faces; their “numbers” were their neighbors, were their friends, was their community.

So what does ACO mean in Nampa, or in any small town for that matter? Did anyone really care? After all, aren’t they just “fly-over country”? When I have given the presentation before the audience reactions were predictable: at first anger, then blame, then acceptance. But not in Nampa—oh no. When we discussed the “whys” of ACOs they smiled, when we discussed the blame they shrugged their shoulders and when we discussed the ACO goals they respectfully chuckled. By the end of the presentation we all agreed that change was inevitable. Call it economic dispassion or progress or whatever; they didn’t really care. In Nampa the hospitals, physicians and, yes, patients all have to come together to see to it that their communities have a healthcare product that fits their needs; “Isn’t that what an ACO is?” someone asked.

As the meeting concluded it occurred to me that the smaller communities are the backbone of medicine in the United States, the front line; they get it because their patients are their neighbors; they acknowledge them in shops, restaurants, centers of worship; they are friends. Their hospital administrators are viewed as their colleagues, working to solve problems, to serve. They understand they have to give to get, to know their limits, to take risks and be accountable; that’s “what we do in Nampa, always have,” I was told.

In Nampa, the confusion, the pettiness and the fleeting nature of the big city doesn’t seem to exist. There’s accountability, there’s permanence—the permanence that I see when I look out my window at the Rocky Mountains.

Robert Provenzano is a nephrologist and Vice President of Medical Affairs, DaVita Inc. He blogs at the ACO Blog.

Prev

New Google and Facebook changes that affect your physician website

June 8, 2012 Kevin 1
…
Next

What can local groups do to prevent obesity in children and youth?

June 9, 2012 Kevin 0
…

Tagged as: Nephrology, Primary Care, Public Health & Policy

Post navigation

< Previous Post
New Google and Facebook changes that affect your physician website
Next Post >
What can local groups do to prevent obesity in children and youth?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Robert Provenzano, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Integrated care cannot change how we behave

    Robert Provenzano, MD

More in Policy

  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Marketing as a clinician isn’t about selling. It’s about trust.

      Kara Pepper, MD | Physician
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Earwax could hold secrets to cancer, Alzheimer’s, and heart disease

      Sandra Vamos, EdD and Domenic Alaim | Conditions
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Marketing as a clinician isn’t about selling. It’s about trust.

      Kara Pepper, MD | Physician
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Earwax could hold secrets to cancer, Alzheimer’s, and heart disease

      Sandra Vamos, EdD and Domenic Alaim | Conditions
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What does an ACO mean in small town America?
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...