On Concurring Opinions, Frank Pasquale J.D., law professor at Seton Hall, describes an ACO as a way to reduce fragmentation of care in his post “Health Reform and Accountable Care Organizations”. ACOs create an “extended hospital” where a “virtual network” of physicians team up with hospitals and agree to be compensated by lump sum payments. If the group keeps costs below payments, gains are shared among members. An incentive exists to work together to keep people healthy. But he cautions, “ACOs could quickly have negative unintended consequences if regulators fail to anticipate the ways they could be abused.”
In The New England Journal of Medicine November Perspectives piece, “Patients’ Role in Accountable Care Organizations,” Anna D. Sinaiko Ph.D. and Meredith B. Rosenthal Ph.D. say, “Understandably, much of the debate about ACOs has focused on structuring provider networks, reimbursing providers, and designing performance-based rewards and penalties for providers. Largely missing from these discussions is a role for patients.” They discuss that for many, “ACO-like models, including Medicare’s Physician Group Practice Demonstration project, patients have been assigned to an ACO through “invisible enrollment,” with no prospective notification and sometimes no awareness that they have been associated with an ACO. Sinaiko and Rosenthal remind us of the past “pitfalls of capitations arrangements” where patients were excluded, warning for ACOs to include consumers.
Vince Kuratis J.D., M.B.A., asks, “Does This ACO Thing Really Mean We Need to Be ‘Accountable’?” after reading The American College of Physicians’ recent paper, The Patient Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices. Stated in the paper:
The care coordination agreements should be viewed solely as a means of specifying a set of expected working procedures agreed upon by the collaborating practices toward the goals of improved communication and care coordination — they are not legally enforceable agreements between the practices.
What are the purposes of ACOs if they don’t hold physicians accountable? Kuratis emphasizes, “The big idea behind ACOs is the notion of accountability, not the specifics of care organizational structure.”
Jim Sabin M.D., a psychiatrist and director of the ethics program at Harvard, answers ‘yes’ to his question in, “Will the Accountable Care Organization (ACO) be a Durable Part of Reform?” He thinks they have the potential to solve care fragmentation. He discusses controlling health care costs and suggests ACOs are an ideal setting for physicians and patients to join together for “public deliberation” for how to ration care.
After reading the New York Times piece, “Consumers Risks Feared as Health Law Spurs Merger,” Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston, reflects on the market power of ACOs in “Transparency and “dial tone” to fight market power.” He rejects two suggestions proposed to combat market dominance: 1) total transparency of rates paid by each insurance company to each provider and 2) complete interoperability of medical records among providers. Instead, he agrees with a magic bullet solution that is just a click away to solving the problem of ACOs dominating the market.
by Sarah Jorgenson
Aftershock:
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