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accountable care organization

ThoughtLeaders: Prognosis for Medicare and Commercial ACOs

A number of pundits are citing the systemic failure of ACOs, after additional Pioneer ACOs announced withdrawal from the program – Where do you weigh in on the prognosis for Medicare and Commercial ACOs over the next several years?”

Republished courtesy of MCOL

Mark Lutes Chair, Board of Directors, Epstein Becker & Green, P.C.

Certainly, if we dial back the rhetoric and the expectations for immediate system -wide transformation, we can expect accountable care organizations to make a contribution […]

Patient “Leakage”: Rethinking Two Field of Dreams Assumptions About ACOs

A study released last week by the Massachusetts Attorney General contains surprising data to challenge two commonly held ACO (accountable care organization) “Field of Dreams” assumptions. These assumptions relate to patient “leakage” — out-of-network patient care and referrals.

1) Hospital administrators assume that tighter physician-hospital integration (e.g., through employment of physicians) will result in “captive referrals” by physicians back to the mother-ship hospital.

2) Medicare administrators are assuming that Medicare Shared Savings ACOs will be able to coordinate patient care even without limitations on patients’ choice to go […]

Will ACO IT Models Be Walled Gardens or Open Platforms?

Will ACO (accountable care organization) IT models be walled gardens or open platforms?  i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network? (If the question still isn’t clear, click here for a further explanation.).

“Does This ACO Thing Really Mean We Need to be ‘Accountable’”

The American College of Physicians (ACP) just released a well-reasoned and thorough position paper, The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices.

As I’ve written before, the Big Idea behind ACOs (Accountable Care Organizations) is the notion of accountability, not the specifics of organizational structure.

The purpose of the ACP position paper is to address the gaps that exist in care coordination when a physician refers a patient to a specialist. The obvious and logical answer proposed is to develop […]

A Dark Horse in ACO Formation: Large Physician Groups

Kudos to the AMGA (American Medical Group Association) for advancing the cause of physician-led accountable care organizations (ACOs)! A few days ago it “convened leadership teams from 22 leading medical groups and organized systems of care at the inaugural meeting of the AMGA ACO Development Collaborative”.

In many communities, hospitals (delivery systems) will be the “natural” organization to lead an ACO. Hospitals bring management expertise, IT, capital, and community relationships to the table as important assets.

Questions about Hospital-Led ACOs

I’ll try to keep an open mind, […]

The Achilles Heel of ACOs? Shared Savings Payment Model Unlikely to Motivate Hospitals

Sometimes you read something and the full impact doesn’t hit you until hours — perhaps days — later.  As I was out mountain biking today, the importance of something I ran across yesterday suddenly hit me.

Accountable Care Organizations (ACOs) are today’s cure-du-jour for reforming the health care delivery system. Bob Berensen, MD of the Urban Institute strongly questions whether the shared savings model under current legislation provides enough economic incentive for hospitals to disrupt their existing core business of acute, inpatient care.

The dialogue […]