Sunday, April 17, 2011

More Thoughts on Accountable Care Organizations (ACOs) From Around The Web

The Disease Management Care Blog toured the web for some additional ACO insights.  The New England Journal wonders if CMS is going to be as confused as the rest of us by the final regulations.  The Health Affairs blog doesn't like how the odds are stacked, while the widely quoted Bob Laszewski doubts the macroeconomics.  Short blurbs and links below.

Reading between the lines of John Iglehart's latest NEJM Perspective article "The ACO Regulations - Some Answers, More Questions," it's easy for readers to get the impression that CMS' policymakers are unsettled. Rather than creating a new healthcare vision, CMS' Proposed Rule is really an attempt to reconcile long-standing notions of managed care versus fee-for-service as well as closed networks versus open choice .  No wonder that Mr. Iglehard describes the new ACO regulations as "a work in progress" that mixes the best of of capitation, fee schedules, attribution and benchmarking that results in more questions than answers.  It's bad enough that the providers will find the 429 pages confusing, but so will the CMS staffers charged with making this ACO patchwork actually function.  This has implications for the ability of CMS to navigate between primary care, specialists and hospitals, provide timely data feeds, calculate savings and deal with anti-trust concerns.

Even without CMS' intelligent support, however, getting an ACOs off the ground will be daunting says Steven Lieberman in this Health Affairs Blog post.  Start up costs are likely to exceed savings, "two-sided" risk .imposes additional burdens, there are significant capital restraints, the quality reporting standards are numerous and complex, "retrospective attribution" dilutes control, the program is operationally burdensome and the interpretation of the regulations promises to be uncertain.  This promises to be risky.

In the end, says the widely quoted Bob Laszewsik, the prognosis for ACOs, may be limited less by CMS' confusion and by all those burdensome regulations than by enduring interest of the health care industrial complex in maintaining the status quo. Bob asks a fundamental question of economics: he wonders how likely is it that providers will be willing to spend money so that they can ultimately receive less money under a shared savings program?  Good point.

In a future post, the DMCB will be reviewing some approaches to these and other questions.

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