Bumps in the Road Turn into Potholes

The big four clinics/health systems (Cleveland, Mayo, Geisinger and Intermountain Healthcare) are not on board with ACO models.

In a recent interview with Congressional Quarterly, a Mayo spokesman said, "Are we interested? Absolutely! But is it feasible? There'd have to be substantial revisions."

So what are the problems that need to be revised?

1. Providers want a bonus system with no penalties;
   


2. Collecting data on 65 quality measures will take expensive technology and additional workforce members;
   


3. Financial solvency requirements would be too hard to meet for all but the largest providers;



4. A requirement that one quarter of the ACO's governing board be beneficiaries raises concerns;



5. Basing the improvement measures on the current expenses of providers unfairly treats low cost - high quality providers;



6. Retrospective assignment of patients and the ability of patients to see non-ACO clinicians without restriction will impact an ACO's cost and quality measures because these patients' experiences will count against the ACO;
   


7. Final rules will not be issued before late summer at the earliest. Meeting these requirements, the financial solvency requirements and having all quality metrics in place by the January 1, 2012 start date just doesn't seem possible;
   


8. CMS's Innovation Center is undercutting possible participation in ACOs by suggesting it will offer providers funding though demonstration projects have not yet been announced.

As Brent James of Intermountain says: "I look at the ACOs coming out as almost fluff and distraction on the side, not that it's not good but it's just that the mainstream is already moving out there on the front line" to other ideas..."We're way past it."

To read the article in its entirety, follow the below link:

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2011/May/May-9-2011/Model-ACO-Health-Centers-Skeptical.aspx