ACOs: What’s with all the skepticism?

Date: 06.07.2013 | Anna Abraham

While Medicare Accountable Care Organizations encourage better health care, federal savings, more efficiency, more financial incentive for physicians and have loads of health care professionals jumping on board daily, we find that not everyone is warmed up to the idea.

Healthcare IT Connect takes a look at three main points from skeptics surrounding Medicaid Accountable Care Organizations.

Dubious Payment Models:

When physicians and hospital executives are asked if they would rather receive Medicaid payment for procedure or for outcomes, as practical thinkers eager to serve the health care industry and receive a return on their enormous investment, they are right to be skeptical. Savings is being forecast for providers with in Medicaid ACOs, but so far few existing ACOs are actually reporting savings. This supports the skeptic view, but does not reduce an ACOs potential.

Of course there is a heap of skepticism surrounding Medicaid ACOs in an industry advantaged from the current Medicaid fee-for-service model. On the opposing side there are industry providers that standardize around best practices, improve efficiencies and eliminate waste, which potentially result in decreased compensation under a fee-for-service model.

The ACO payment model goal is to earn financial benefits by contributing efficiencies for the Medicaid program. An ACO’s financial reward allocation method among the providers will be a fluid process. It’s important for health care professionals to carefully look at all compensation models.

Critical, Expensive and Complex IT:

There is a lack of ACO advocacy from health care providers who don’t have the analytic capabilities to engage. Four main IT solutions challenge a successful Accountable Care Organization: EHRs, HIE, Big Data Analytics and Patient Portals for care management. Each is crucial and must be an integral part of a health care provider’s business model.

The simple objective to integrate Health IT into workflow is actually quite complex. Health care CIOs are working through all kinds of hurdles to find effective gains and actionable solutions. For the ACO skeptics this means a huge initial investment and cutting and pasting IT to help them keep costs down and carefully meet quality benchmarks.

With careful application these complex IT solutions are making health care more readily available and affordable giving providers higher ROI and interoperability opportunities.

Au Revoir to Private Practices:

There are questions about the future of autonomous, private delivery of medicine. Some experts say in order for big government to calculate bottom lines they prefer big business to independent autonomous practices. This could lead to more hospitals and fewer private practices. The assumption is that private practices will sell to hospitals in order to join ACOs because the competition and costs will simply be too high.

The key that private practices need to know is that they’re not alone. Pulling together in their awareness of each other’s value, participation on best practices and innovation can counterbalance the power of hospitals. They can form a larger single-specialty group, an independent practice association (IPA), or some other clinical integral vehicle to maintain their autonomy. A successful IPA for example will greatly affect the structure of the arrangement with an ACO. These physician-led ACO structures may be less burdened by shifting financial risks and more likely to receive financial bonuses. After all, the whole point of an ACO is to work together to improve quality.

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