Learning to live in an accountable care world

Value may have been the word of the year in radiology and across healthcare in general. At nearly every professional conference, speakers seemed laser-focused on the concept of shifting healthcare in the U.S. from a volume-based, fee-for-service model to a system that emphasizes value and patient-centered care.

The vanguard of this model are the early accountable care organizations (ACOs) that have formed in recent years. While all ACOs have different payment structures, the basic premise has always held promise—use the financial incentives of shared savings or capitation to encourage adherence to quality metrics that lead to higher quality care at a lower cost.

But have hospital administrators bought in? One of this week’s top stories suggests many are taking a “wait and see” approach. A survey of more than 200 hospital leaders found nearly half have no plans to implement ACO models, according to the study conducted by Resolution Research on behalf of Indiana-based nonprofit Purdue Healthcare Advisors.

When asked to explain why, 52 percent of the more tentative administrators said they first wanted to see stronger evidence of consistent success in current ACOs, while 49 percent said they believe their hospital is too small for an ACO-like model. Others were more skeptical, with 26 saying the financial investment outweighed the potential incentives and 13 percent felt the performance benchmarks were unrealistic for their organization.

With so many waiting to see results from ACOs, it’s fitting that one of the week’s other top stories was a study of 10 institutions participating in the CMS Physician Group Demonstration Project (PGDP) looking at the effect of a CMS initiated shared savings model. Participating groups were required to comply with 32 quality measures and could receive payments of up to 80 percent of generated savings.

The study, published online Dec. 13 in the Journal of the American College of Radiology, found that most participants did very well on the quality metrics. By the end of the five-year project, seven participants achieved benchmark-level performance on all 32 measures and the rest achieved such results for at least 30 of the measures. However, the model was not quite a silver bullet for reducing costs, with savings lagging compared to the success seen on the quality measures—only two participants surpassed the 2 percent savings threshold in the first year of the project and only half met the threshold after three years.

The lessons learned by early adopters of shared savings models should be carefully studied so that successes can be emulated in the years to come.

A quick programming note: Monday, Dec. 23, will be the last Health Imaging newsletter of 2013. We’ll return with our coverage on Friday, Jan. 3. Have a wonderful holiday season and a happy new year!


-Evan Godt
Editor – Health Imaging