Difficult questions remain about the accountable care organization (ACO) model, despite the government’s softened stance with final regulations. There’s little doubting the inherent risk and the technical challenges hospitals considering such a transformation face.
[Commentary: Will the final ACO rule lead to a new paradigm?]
Government Health IT Editor Tom Sullivan interviewed Wendy Whittington, MD, MMM and chief medical officer of Anthelio Healthcare Solutions, about those risks and obstacles – and whether hospitals will really profit from the ACO approach.
Q: You made the case that "hospitals are not designed to benefit from an ACO model" and that they will only lose money by trying to become an ACO. Does that mean the entire Medicare Shared Savings Plan and even the ACO model are bound to fail?
A: I think saying it is “bound to fail” is a bit of an overstatement. It is still in the best interest of all of us if we can work together to keep patients healthy. If any group or organization does an excellent job at care management and maintaining efficiencies, there is the possibility that the money left over in the ACO pot once the patient is properly cared for and the funds doled out could be incentive to the right organization. My point is more that it seems a little backwards that we make the assumption that hospitals will be best at or even want to administer ACOs. Unless we fundamentally change our entire system, there is still this disconnect in the incentives for hospitals as we know them today. The whole point of accountable care is preventive medicine to keep people out of the hospitals whenever possible and to maintain their health in more appropriate settings. This is especially true when we consider the inappropriateness of using expensive emergency departments for simple acute care like sore throats and earaches today.
Q: A report published recently found that healthcare organizations failing to implement technology and practices to support better outcomes and quality "risk long term clinical and financial failure." ACO or otherwise, what are providers to do?
A: The right thing to do is still to figure out ways for providers to appropriately use technology and share data in a responsible manner. The patient will ultimately benefit when we do this. The gray zone here is in where the responsibility lies in maintaining that data and making those tech investments to achieve an excellent final outcome. We need to see incentives aligned better or providers will feel damned if you do if they need to pay for a platform that doesn’t necessarily pay off for them in the long run.
Q: For providers, the shared savings incentives garner the most attention, but what are the other pros of ACOs? The cons? What are each for payers?
A: Simply put, the patient and the payer have the most to gain by a patient getting appropriate care without duplicate testing in the right place at the right time for the right reasons. For the patient the benefit is obvious. For the payer, simply put, if there is one pot of money to keep a patient healthy or to pay for an episode of care and that money is spent wisely and efficiently, they will be able to demonstrate in the long run that it is justifiable to pay the ACO less and less. A well run ACO can make a margin but I question how long those margins will be allowed to stay worthwhile for the ACO. Medicare, rightly so, has a clear goal to continue to cut costs over time. We simply cannot afford as a nation to continue spending at the rates of increase we have been spending on Medicare annually.
Related coverage:
HIMSS legal corner: Why HIE is indispensable to ACO success
Q&A: The deep, wide gulf between ACO regs and reality
The HIT of ACOs -- Part 1: Data analytics, and Part 2: Beyond health information exchange
Q&A: On ACOs and the 'cartelization' of healthcare
Steve O'Keefe's My Cup of IT: ACOs: Doctors differ, patients die
Feature: The 5 roadblocks HIEs face
Q&A: On the trials and tribulations of unlocking patient data
