The Accountable Care Organization mandate in the health care reform law needs some fine-tuning before it takes effect, according to industry lobby AdvaMed, and could use an independent oversight board to make sure the system doesn’t stint on care for Medicare patients.
The Accountable Care Organization initiative aims to shift the business of health care delivery from a fee-for-service model to one that pays hospitals and care providers based on quality of care, coordination of care and cost-effectiveness. It’s slated to kick off on a voluntary basis Jan. 1.
In an opinion piece published on the Health Affairs blog, AdvaMed president and CEO Stephen Ubl writes that the ACO program “is the right treatment to fix the ills of our nation’s health system,” but warns that it runs a “real danger of stinting on care” for Medicare patients.
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“By bringing ACOs into Medicare, the federal government is exposing elderly and disabled patients to a new shared financial savings model — one that gives hospitals and physicians bonuses based on the strength of their performance in economizing and that, under the draft ACO regulation, also penalizes doctors and hospitals who do not achieve spending targets,” Ubl wrote.
The ACO system needs “protections to ensure appropriate care for individual patients,” namely an independent oversight board to prevent “arbitrary ‘stinting'” from rationing care for individual patients.
“The ACO draft regulations include provisions for monitoring by CMS, but an independent monitor could ferret out problems that CMS might not identify and would contribute to public confidence in the new entities,” Ubl wrote. “Public release of monitors’ findings would help ensure a degree of protection for Medicare beneficiaries.”
AdvaMed also likes an idea from the Office of the Inspector General to reward individual physicians based quality scores, rather than cost savings, and reward hospitals and group care providers based on economic measures.