The search is still under way to find the ideal U.S. healthcare payment model and while more and more fingers are pointing to accountable care organizations (ACOs) as the possible savior of healthcare reform, it remains unknown whether ACOs will be all that they are promised to be.
In fact, ACC President Jack Lewin, MD, dubbed ACOs healthcare's “ Bigfoot," saying that “no one really knows exactly what the ACO entails but we think we would recognize one if we saw one.”
While some have suggested that the ACO will cut costs, improve care and increase patient satisfaction, others argue that the ACO may actually raise costs, particularly during the implementation phase.
In fact, a recent American Hospital Association (AHA) study found that ACOs may cost between $11.6 million and $26.1 million to implement and sustain, an amount much greater than the $1.8 million estimated by the Centers for Medicare & Medicare Services (CMS).
This week, a gang of seven GOP senators sent a letter to the Department of Health and Human Services Secretary Kathleen Sebelius and CMS Administrator Donald Berwick, urging that ACO regulations should be upturned and rewritten. The senators argued that even top-notch providers, such as the Billings Clinic in Billings, Mont., Intermountain Healthcare in Salt Lake City and the Cleveland Clinic, said that the ACO definition could displace accountability. The senators wrote that it was “increasingly clear that this proposed rule misses the target.”
The ACO model will require a paradigm shift, but at this point we wonder where that shift will direct us. Are ACOs the real answer to curbing high costs and improving outcomes? Or should individual hospitals already be holding themselves accountable for readmissions and unnecessary costs? Moving from a volume-based system to a value-based system will be difficult, but necessary.
Until ACOs are further defined and providers see that the benefits outweight the high upfront costs, the move toward ACOs may be put on hold. We'd love to hear your comments on where the U.S. healthcare payment model should be or is headed.