Leaders of healthcare systems, hospitals and healthcare payers are on the fence when it comes to their participation in the Centers for Medicare and Medicaid Services' shared savings program (MSSP) – the Medicare ACO program – according to a recent poll led by KPMG LLC.
According to responses to webcast polls conduct in April, 39 percent of hospital and health system executives didn't know their organization's position on participating in the MSSP. Another 25 percent said they were taking a wait and see approach, which wouldn't allow them to be ready for the launch of the program, currently slated for January 1, 2012, under the current rules proposed by CMS.
Among the payer group, nearly half said they didn't know what their organization's stance was on the MSSP and 21 percent were taking a wait-and-see approach.
[See also: NEJM article spotlights financial risks associated with ACOs; CMS ramps up for ACOs, seeks physician input]
"There are still important questions about how accountable care fits into an organization's current strategy and business model, along with competing investment decisions, such as those related to ICD-10 and upgrading information technology," said Brad Benton, KPMG Healthcare's national account leader in a press release announcing the results. "There are also enterprise-wide business considerations related to adopting an ACO model which are complex to evaluate, but the transformation of the U.S. healthcare system is underway and all healthcare organizations need to actively consider the related business model implications."
While healthcare leaders are in favor of the MPPS' gain sharing opportunities to both improve outcomes while reducing costs, they may face obstacles in launching an ACO due to expected resistance from physicians. Thirty-six percent of poll respondents saw physician buy-in as the greatest obstacle to launching an ACO, while 31 percent cited the costs involved as the biggest roadblock. Other potential barriers to ACO formation included having the right staff and skill set (cited by 22 percent) and management buy-in (11 percent). Payer respondents listed the same concerns in the same order.
"Clinical leadership and integration will be a key ACO operational consideration," said Benton. "The challenges here are not only the typical recruiting and economic alignment questions, but a host of new and intense change management issues associated with driving both cost and quality in a new type of clinically integrated organization. It's a complex transformation challenge of the highest order."
One reason there may be hesitance to participate in the Medicare ACO is that CMS is still working on the exact rules for participation and has left many healthcare executives with as many questions as answers.
"There isn't a single definition of what an accountable care organization is, or what its components should include so there is some confusion," said Joe Kuehn, a partner in KPMG's Healthcare Advisory Practice. "The proposed MSSP program has added to the complexity of the discussions and analysis of what it will take to successfully operationalize a Medicare ACO and this may be causing many potential ACO market entrants to pause. However, organizations seem to want to be accountable care 'capable,' focusing on specific populations to bring about improved quality and health, at a reduced cost, and they are seeking ways to clinically integrate with their physicians and other potential partners."
Poll results for the study were derived from a three-part ACO webinar series conducted in April by The KPMG Healthcare & Pharmaceutical Institute, EpsteinBeckerGreen, and JHD Group. Participants self-selected and reflect responses from 140 healthcare providers and 50 payers. In all more, than 3,000 executives participated in the webinars.