I have not had any clinical experience with Medicare to write about (fortunately) so that will have to wait. Much to my surprise, however, I did receive a birthday greeting!Dear JOHN R PATRICK Happy Birthday from Medicare! We wish you well in the upcoming year. Our records show you are currently up-to-date on your preventive services. (Not sure what records they have) Congratulations on using Medicare to help you stay healthy. We will send you emails in the future as you become eligible for other Medicare preventive services. So you can plan and schedule your appointments, the following calendar shows the services that you may be eligible for over the next twelve months…. The email went on to recommend specific preventive examinations that I would be eligible for by month of the upcoming year. “To see a schedule of the services you are eligible for, visit www.MyMedicare.gov and select the “My Preventive Services” tab. Or, talk to your doctor for more information. Remember, Medicare is your partner in health. Sincerely, Centers for Medicare & Medicaid Services”. If I pursue all of the preventative examinations and tests that are recommended I will be a very busy person. Is there such a thing as too much care? Should care be “rationed”? These terms easily become highly emotional in both clinical and political terms. Some say that Americans have too big of an “appetite” for healthcare services and there is a tug of war going on between the payers, the providers, the patients, and the politicians over what care should be provided. The answer is not more care or less care but more effective care. The model of paying for more visits, tests, and procedures is what has to change. An emerging new model to address this is called the “Accountable Care Organization“. An ACO relies on close hospital partnerships, collaborative alignment with physicians, robust information technology infrastructure and operational expense management While the federal government is studying various models, the healthcare industry is moving toward the ACO model which relies on the partnerships between healthcare providers to reduce healthcare costs while maintaining or improving quality of care. Successful ACOs will be rewarded financially, providing additional resources to invest in technology, jobs and other improvements in the delivery of care. The concept of the ACO is to have money flow to the ACO to keep patients healthy and have the money be allocated among the various providers — primary care physicians, specialists, laboratories, imaging centers, etc. Needless to say the method of allocation may be complex and contentious but over time the results could be quite positive for everyone. One thing is for sure and that is that the current model is badly broken and unaffordable. When a 92 year old patient has an indication that a colonoscopy should be performed — knowing that surgery will not be performed regardless of the outcome of the examination — who is benefiting from the expenditure? When an elderly person is incapacitated and a wheelchair can dramatically improve their quality of life then it is a good investment by Medicare. When a person is grossly overweight because they enjoy Krispy Kreme doughnuts does the spending of millions of dollars on TV advertising to entice that person to get a Medicare-paid “free” sporty electric wheelchair, is that effective or might diet and exercise combined with visits to various members of the ACO be a better investment for Medicare? I think we all know the answer. Be on the lookout for the term ACO. We will be reading much more about this in the local and national news.