ACO buzz kill: Micromanagement, bureaucracy

Despite efforts to cut costs and improve care through coordinated teams of providers and organizations, accountable care organizations (ACOs) are filled with bureaucracy and micromanagment, according to an editorial published in The Wall Street Journal.

The ACO proposed rule from CMS racks up a long list of opposition, namely, the nation's top hospitals (e.g., Mayo Clinic, Geisinger Health System) and physician professional associations (e.g., American Medical Group Association, American Medical Association) that reject the regulations, including early supporters who were originally on board with the concept.

Even though participation is voluntary, the draft rule of ACOs is essentially a new business model from CMS, according to the editorial.

"...the providers that are already closest to being an ACO have rejected the Administration's handiwork," states the editorial. "And no wonder, since the 429-page rule is a classic of top-down micromanagement. ACOs will need to comply with a kitchen sink of 65 clinical measures that are meant to produce efficiencies, like reducing infections or ensuring that patients take their medications after hospital discharge. If care at an ACO costs less than Medicare predicts it will cost under the status quo, then the ACO will receive a share of the savings as a bonus payment. The rule also includes financial penalties if an ACO misses its targets."

Meanwhile, the second National Accountable Care Organization Summit will convene next week in Washington, D.C., where D.C. leaders and think tanks will discuss payment models, legal issues, IT integration, and healthcare delivery.

For more:
- read the Wall Street Journal editorial