Section 3022 of the Affordable Care Act (ACA) establishes the Medicare Shared Savings Program for accountable care organizations (ACOs) as a potential solution.1 The creation of ACOs is one of the first delivery-reform initiatives that will be implemented under the ACA. Its purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care. Under the law, an ACO will assume responsibility for the care of a clearly defined population of Medicare beneficiaries attributed to it on the basis of their patterns of use of primary care. If an ACO succeeds in both delivering high-quality care and reducing the cost of that care to a level below what would otherwise have been expected, it will share in the Medicare savings it achieves.
On March 31, 2011, the Department of Health and Human Services took a major step toward establishing ACOs by issuing a notice of proposed rule-making that will define how physicians, hospitals, and other key constituents can adopt this new organizational form. The issuing of the proposed rule follows months of obtaining informal and formal input from throughout the health care delivery system, but at this point the rule is only a proposal. The Centers for Medicare and Medicaid Services (CMS) will carefully review the comments we receive in response to the proposed rule before issuing a final rule later this year.
The ACOs are in effect hospital owned and controlled care organizations. For Berwick in my opinion, who allegedly was formerly related to one of the largest Massachusetts health care conglomerate this plan may be a God send. It drives the independent physician out of business while removing choice totally from the Medicare patient.
Let me explain why. First if a patient has say multiple problems, say prostate cancer, heart issues and say a tendency towards say melanoma, he will be "serviced" by a hospital based ACO. An all service vehicle. So if the melanoma can best be served by a regional cancer hospital, too bad, he is stuck with the ACO. The ACOs will in my opinion be the HMOs of the 1990s. CMS will in my opinion most likely use its heavy hand to drive those in Medicare into the ACOs.
The good doctor states:
Accountable care is not a panacea but rather one of a number of complementary initiatives chartered by the ACA to help achieve the three-part goal of lower costs, improved care, and better health. Other delivery-reform efforts such as expanded use of medical homes, bundled payments, value-based purchasing, adoption of information technology, and payment reforms are under way or under consideration. A critical success factor for ACOs will be their effective integration with these other efforts.
Yes it is not a panacea, it is in my opinion a way to recreate HMOs and even worse drive them into the hands of the mega hospitals! It is just one element of cost containment and rationing. Why rationing, because the ACO will become the gatekeeper. If the patient has the knowledge and wisdom to work their way through the system, the way will now in my opinion most likely be blocked with the developing Berwick rules.
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