Accountable analysis

Mary Stevens, editor, CMIO magazine

What does the “accountable care organization” discussion mean to you? It’s been the phrase du jour for many months, and since the ACO guidelines were announced at the end of March, ACO-focused news and analysis have hit flood level. Academics, industry analysts, providers and payors are trying to decipher CMS’ 400-plus pages of proposed rules that will shape ACOs. Their revelations cover many aspects of these proposed organizations and some of the findings are contradictory. Consider:

ACOs could exclude FQHC patients. Depending on how CMS interprets PPACA rules, “downstream consequences” such as systemic exclusion of the poorest and most underserved patients could occur, according to a research brief from Geiger Gibson/RCHN Community Health Foundation Research Collaborative.

ACOs will be expensive to start. One study pegs participation costs at $489,354 to initiate the project and $1,265,897 to operate it in the first year. The same physician group practice model estimated that the reduced cost per Medicare beneficiary would be $120.

ACO accreditation is under construction. Ten organizations recently completed a month-long pilot test to see if they could reasonably collect and submit information required for an ACO accreditation program proposed by the National Committee for Quality Assurance (NCQA). The test marked a final step in the year-long collaboration between NCQA and stakeholders to create ACO standards that will improve these new entities’ chances of success in achieving improvements in quality and value. NCQA will review the data collection and submission process before issuing its final ACO standards.

ACOs will benefit providers and patients—if they’re built on a foundation of primary care, have robust reporting capabilities and can ensure prompt rewards for high-quality care, according to a Commonwealth Fund study.

ACOs themselves are works in progress. In something of an understatement, the same study reported: “Many issues need to be addressed, including the methods of determining how accountability is to be achieved, assessed and rewarded.” In addition, the proposed rules don’t include specific models that ACOs must follow. That will allow some flexibility, according to CMS, but it will also lead to more questions and uncertainty, at least in the short term.

It’s very early yet in the transition away from today’s fee-for-service care toward pay for performance. Although there is general agreement that the current fee-for-service system isn’t working well, that might be the only consensus point for some time to come. The accountable analysis flood likely won’t crest for some time to come.

Have you had time to analyze the proposed ACO rules? What should change? Let me know at mstevens@trimedmedia.com.

Mary Stevens, editor