ACO Update: What Challenges Lie Ahead?

In June, we noted that Accountable Care Organizations (ACOs) have proliferated throughout the United States in the past few years, but they are still a comparatively new model for delivering low-cost, high quality care. As of mid-2013, there were over 4 million beneficiaries covered by Medicare ACOs. Additionally, a report identified 537 ACOs, and found that the number of physicians, nurse practitioners, and physician assistants participating in ACOs exceeds 190,000. Currently, there are nearly 289,000 total healthcare providers and business personnel aligned with ACOs. Despite these growing numbers, two interesting articles were published describing the difficulties facing ACO growth. First, Dr. Robert Pearl, M.D., described the four major challenges facing ACOs: (1) Perverse Payment Model; (2) Wrong-Sized Medical Staff; (3) Technology Platform Incompatibility; and (4) Lack of Physician Leadership and Management Structure. Obstacle 1: Perverse Payment Model Dr. Pearl states that the “prevailing fee-for-service payment model rewards volume of services, not superior clinical outcomes. The more procedures performed, and the more complicated the treatment, the more providers are reimbursed.” He notes that in the short term, it is easier to “generate more volume and immediately increase revenue than it is to redesign the health care delivery process, creating greater value over time.” “It comes down to a battle between what’s best for the patient and what’s best for...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs