As someone who learns more about the Patient Protection and Affordable Care Act each day, I have to say that I enjoyed reading the recent cover story (“Tests were inconclusive,” Nov. 1, p. 6) about California's experiment with accountable care organizations. However, reading this article did raise one issue for me. About halfway through the article, the author quoted Jerry Penso—medical director for the continuum of care for Sharp Rees-Stealy Medical Group and, assumingly, an authority on ACOs—who stated that ACOs are like car dealerships. Car dealerships? Now, I understand that the car dealership model provides a good example of the basic idea the author was trying to convey—that ACOs will provide an all-in-one approach to patient care. But, is a car dealership the best example? As far as I know, not all people feel assured with the services they receive at car dealerships. In fact, car dealerships have been viewed as providing the least reliable services at the most expense to customers. The last thing I'd like to see when reading about new, promising aspects of our healthcare reform is a comparison to a service industry with identifiable faults. But maybe Mr. Penso's example is right. Maybe ACOs are destined to mimic car dealerships. If that's the case, let's just hope that our new system doesn't entirely go the way of the auto industry.
James ShannonKitch Drutchas WagnerValitutti & SherbrookDetroit