Berwick: Some claim ACO status without truly changing

CMS Administrator Dr. Donald Berwick has noticed that not everyone tells the truth when it comes to accountable care organizations.

Last Friday during a keynote address at the National Committee for Quality Assurance's policy conference in Washington, D.C., he told the crowd that some people are trying to depict their organizations in a new light as ACOs, without truly changing. "You've discovered you've always been an ACO," he said.

"Cloaking the status quo is not authentic," he said in a rare stern moment.

Later that afternoon, Jonathan Blum, CMS' deputy administrator and director, offered some broad guidelines to help define what ACOs are and what they are not. Because CMS is engaged in what he called "predecisional" rulemaking considering input from stakeholders, he couldn't go into much detail.

They are not a tool to simply dominate a market, he said. "We don't see ACO programs as one to allow hospitals to dominate hospital markets."

What's notable is that ACOs at this point seem to be polymorphous and ever evolving. ACOs are not limited to one model, Blum said. An ACO could be a group of large physician practices or coalitions of small office practitioners, for example. And they are not static organizations serving in static programs. ACOs must continuously improve and evolve, he said.

Nor are ACOs organizations that roll the dice and earn one-sided shared savings, as envisioned by a 2008 Congressional Budget Office report.

An ACO will always put the patient first," he said. ACO programs should serve the chronically ill, high-need patients. Expect ACOs to perform better on clinical outcomes and costs than traditional fee-for-service programs.

CMS sees ACOs as data-rich organizations, Blum said, noting that organizations will need more access to Parts A, B and D data.

The proposed rule that offers more specifics on what will qualify as an ACO won't be out until mid January.