Although surgical procedures are among the most expensive of claims, Accountable Care Organization (ACO) cost reduction efforts don’t pay much attention to surgery as an area where possible waste in healthcare delivery may occur finds a new study published in Health Affairs.

Policy researchers from the American College of Surgeons, Harvard Medical School and the think tank Brookings Institution examined the experience of 59 Medicare-approved ACOs and found that all were largely focused on primary care changes and comparatively little if any effort had gone into projects to make specialty care, and in particular surgery, more cost effective. Surgeons also were under-represented in ACO leadership.

The researcher predicted that eventually ACOs will focus more on surgical care and use data on outcomes and costs to make referrals more scientific. This change in referral patterns will in turn create the incentive for surgeons, hospitals and surgery centers to focus on efforts to reduce waste and improve results.

However, the authors also noted that of course local market conditions could restrict ACOs’ abilities to change surgeons’ behavior through more cost and quality based referral patterns.