Real Entrepreneurship at Work
Of the 27 ACOs that CMS announced on Tuesday (April 10), only two chose the model that penalizes accountable care organizations for not meeting cost and quality measures in exchange for bigger bonuses when they do achieve those benchmarks. CMS Medicare chief Jonathan Blum said the ACO program is off to a “phenomenal start,” but ACO consultants said the lack of interest in the two-sided risk model shows that it could have been a disaster if CMS had stuck to its original plan to force that approach on all ACOs.
Full article in Inside Health Policy worth reading.
I doubt you will find any health policy wonk who would argue we don’t want health care providers to somehow be held accountable for the care they provide. However, the current fad (i.e. Accountable Care Organizations) is unlikely to achieve that accountability. When you get down to the heart of the matter, no organization should be held accountable for anything they have no control over. This suggests patients themselves should be accountable for certain expenses, doctors and hospitals should be accountable for certain things (e.g. quality at a given cost) while insurers should be held accountable for certain metrics. The idea that vertically integrated organizations would achieve cost savings for episodes they have no control over and firms would achieve desirable cost benchmarks they have no incentive to achieve is hard to fathom.
If it works for the two that chose the model, maybe other ACOs will switch to it.
What would the disaster have been? No one would have signed up as an ACO. It appears they’re not going to achieve the savings they want, unless they use an HMO model.
I’m still not convinced that ACOs will work. I’ll believe it when I see it.