The focus of the national media and sites such as this one has been on the promise of Accountable Care Organizations (ACOs) to transform the American healthcare delivery system in a way that the country can "bend the cost curve" of healthcare. I don't want to be the one to rain on anyone's parade, but the test of that premise is yet to come and the devil, as they say, is in the details.
Ian Morrison is among the most insightful and provocative futurists and healthcare commentators in America. He recently wrote, "an organization that claims to be an accountable care organization is probably not accountable to a defined population; they likely don't care for patients beyond a few isolated episodes; and are probably not very well organized." He goes on to explain that other than those who have a historic claim to have done this all along, others are merely pretenders with much to prove.
Here are some of the challenges ACOs may face in meeting expectations that have been set:
Will meaningful implementation with tangible financial results be achieved soon enough to mitigate what most knowledgeable observers agree is an impending economic crisis driven by healthcare costs? One report I reviewed indicated that initially the federal government will only approve those for ACOs that have a track record of operating as an integrated provider organization. Bringing others along is going to be a long process.
What about patients? How will Medicare patients be encouraged or directed to join ACOs? Morrison says patients would be assigned by "attribution logic." Good luck in assigning members of our most influential political lobby to anything. Why will Medicare enrollees transfer willingly to an ACO when standard Medicare gives freedom of choice to select providers and Medicare Advantage has some limits on choice but with additional benefits at no increase cost to the enrollee and higher payments to doctors? I can just hear it now, "keep the damn government out of my Medicare health insurance."
Will physicians be willing and active participants or will they be dragged into ACOs against their will? Recent studies have shown a significant majority of physicians support fee for service payments. Another survey found only 16 percent of the physicians polled favored bundled payments. These figures don't represent the kind of backing needed to make ACOs successful.
And finally, do ACOs have any likelihood to expand beyond contracted relationships with the Medicare program? The health insurance and business lobbies have already begun to circle the wagons to prepare for the fight against the expansion of ACOs. They point out that the consolidation of market power within ACOs will only lead to higher healthcare expenditures in the private sector.
Hey, I'm from the new "show me" state, California. We've tried all of what I refer to as expensive and ineffective "work-arounds" over the years in the hope that our state's fiscal crisis would be resolved without any real pain. Well, there are no easy answers. Are ACOs simply an attempt to avoid reality? Let's hope we get the answer before it is too late to prevent a massive healthcare meltdown.
Mike Stephens blogs regularly at Action for Better Healthcare.