All quiet on the ACO front? Not really ...
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| Mary Stevens, Editor |
Even so, an informal survey of my inbox showed that, during the past two weeks or so, invitations to ACO-oriented presentations from various vendors and organizations have surpassed those dedicated to various aspects of meaningful use.
Earlier this week, the American Medical Association this week provided members with ACO principles. The AMA calls for ACOs that are lead by physicians, ensure voluntary participation of both patients and providers, and “enable independent physicians to participate,” among other things.
However, a New England Journal of Medicine perspective piece published yesterday counters that a physician-led model may be difficult to implement because it requires clinical, administrative and fiscal cooperation. “Physicians have seldom demonstrated the ability to effectively organize themselves into groups, agree on clinical guidelines and device ways to equitably distribute money,” the authors wrote.
They argue that hospital-controlled ACOs, which will employ physicians, might be a better approach, but have their own set of clinical, administrative and fiscal pitfalls: “Building an ACO will require hospitals to shift to a more outpatient-focused, coordinated care model and forgo some profits from procedures and admissions,” the authors wrote. “Hospitals’ decisions will be further complicated if payors do not change their payment models similarly and simultaneously.”
Many healthcare organizations are not taking a wait-and-see approach to ACOs. A story in our November issue of CMIO explains how some providers consider the patient-centered medical home model to be a steppingstone to the ACO and are preparing to make the transition.
Recently Zynx Health launched a pilot program aimed at retooling clinical decision support for ACOs, joined by five large-system test sites: Cedars-Sinai Medical Center in California, Memorial Hermann Healthcare System in Texas, Northwest Hospital & Medical Center in Washington, St. Joseph Health System in California and Texas, and WellStar Health System in Georgia.
What’s not to love about a team-centered approach that cares for the entire patient, not just a single condition; or a payment plan that rewards outcomes, not patient volume? Potential up-front IT and personnel costs, particularly for smaller practices, for one thing. The prospect of trading lower revenue in the undetermined “short term” for long-term savings and care improvement will be a hard sell in some areas.
For another, the administrative issues can’t be wished away; the at-times adversarial relationship between providers and payors won’t change overnight.
It will be interesting to see how this all unfolds. What are your thoughts? Let me know at mstevens@trimedmedia.com
Mary Stevens,
Editor of CMIO