Medical Device Daily

Concerns regarding the implementation of Accountable Care Organizations (ACO), as spelled out by Health Reform legislation, were the subject of a conference call hosted by the Advanced Medical Technology Association (AdvaMed; Washington) on Monday. While AdvaMed gave positive marks to the new payment program, which will be established under Medicare, the organization said that there were some genuine issues that need to be resolved before ACOs are firmly established throughout the U.S.

It pointed out that a sizeable chunk of the American public would be affected by this plan.

“CBO estimates that 40% of Medicare patients will be enrolled in ACOs,“ David Nexon, senior executive VP, AdvaMed told attendees of the audio conference. “That's 20 million senior citizens.“

He added that “what's in the ACO is going to be terribly important in shaping the healthcare [landscape].“

An ACO would consist of doctors, hospitals and other providers that would offer seamless care throughout the stages of treatment. This kind of coordination would seemingly require integrated healthcare information technology and also that doctors would be willing to give up at least some autonomy.

The proposed ACO regulation would come out some time early next year.

One of the key issues according to AdvaMed, is the way in which performance standards in the ACO program will be reached.

Nexon said that there is a great potential for institutions to cut corners to successfully meet ACO standards.

But that could come at the cost of “skimming on care and not giving patients what they need,“ he said.

Rigid spending targets or benchmarks along with the prospect of saving could discourage providers from offering the medical advances and new treatments needed for patients - especially when “these are more expensive than older treatments,“ the organization said.

To combat this issue, AdvaMed suggests that ACO spending targets should be adjusted to avoid discouraging providers from adopting new treatments and medical advances for their patients.

It further suggests that participating entities should be required to establish protections for individual physicians and other providers that do not penalize them for being early adopters of new treatments or for participating in clinical trials. Another issue is financial incentives offered to ACO providers for reducing costs and sharing in savings that could possibly interfere with their patient-centered clinical decision making.

“We think more of a per capita [shared savings payment] as opposed to an individual incentive and some sort of cap,“ Nexon said. “There's a potential issue from ACO where physicians could get over rewarded.“

AdvaMed also said that it takes issue with the amount of transparency present in the ACO program.

Measures in place now make it difficult for CMS to assure beneficiaries that performance measure reporting alone will be a sufficient safeguard against inappropriate ACO actions motivated only by the desire to produce savings, according to Ann-Marie Lynch, executive vice president for payment and healthcare delivery policy, AdvaMed.

“We're calling for an independent monitor over ACOs so patients can receive the best care possible,“ Lynch said.

The organization suggests developing and implementing a comprehensive independent monitoring program to assess beneficiary and caregiver experience of care, monitoring appropriate beneficiary access to care within an ACO including access to medical technologies and specialists, comparing ACO models of care to non-ACO models, surveying participating beneficiaries and caregivers, and establishing an appeals and grievance system.

All findings from the monitor would be made available to the public to maintain transparency.

AdvaMed also asks that beneficiaries be anonymously surveyed regarding their assessment of the care available to them through the ACO as compared to the care they received in other Medicare payment models.

These surveys would be conducted shortly after enrollment, one year after the roll-out of the ACO program and on a periodic basis thereafter.

Nexon said that the ACO program has the potential to be the right “recipe“ but in order for the program to be effective it would need the right “ingredients.“

He added that the fee for service system has proven itself ineffective at achieving stronger quality care models or reducing the cost of healthcare.

“We all know that the fee for service system is neither good at improving the quality of care, or reducing the cost,“ he said.

Omar Ford, 404-262-5546;
omar.ford@ahcmedia.com