Do accountable care organizations (ACOs) produce better patient outcomes? That's still up for debate in the hotly contested issue with some supporting coordinated care and others slamming the financial incentives.
At Jackson Memorial Hospital in Florida, a care coordination pilot program to reduce readmissions through follow-up care has shown promising results in improved outcomes. For example, after discharge, patients are visited by nurses at home who provide healthy frozen meals and ensure they are adhering to their medication. Since implementation, readmission rates in heart patients dropped by a third, reports the Miami Herald. The $81,000 investment also saved the hospital $400,000 in readmission charges.
"It's a wave that's occurring," according to University of Miami health policy professor Steven Ullmann, who said the ACOs are still up for debate. "You're starting to see the preliminary adjustment going on. The jury is still out on how much it's going to do."
Organizations and providers, alike, however, still remain skeptical about the benefits and costs savings of ACOs that may have yet to prove themselves.
"My concern is that the larger hospitals are going to be at the front of this, because they have the capital," said Bernd Wollschlaeger, a family practice physician in North Miami Beach and former president of the Dade County Medical Association. "A group of physicians may not reach a critical mass."
With allusions to the failed HMOs and managed care organizations of the past, the cost incentives for care poses a conflict of interest, said Dr. Steven Horvitz in an editorial on phillyBurbs.com, the online component of the Bucks County Courier Times, Burlington County Times, and Doylestown Intelligencer.
Calling it a "dream to insurers," ACOs could become a nightmare for patient care if clinicians stop ordering needed tests to save costs, he said.
Medicare will penalize 30-day readmissions by reducing reimbursement by 1 percent starting in 2013 and 3 percent in 2015, according to Ullmann.