Quality missing from ACO equation?

Although most often applied to the Medicare Shared Savings Program or the Pioneer Accountable Care Organization, the term ACO has far-reaching applications, including those outside of the federal programs. But critics argue that perhaps the ACO term is used too liberally, such as with the recently announced success of the "largest commercial ACO" of Advocate Health Care and major health insurer Blue Cross Blue Shield of Illinois (BCBSIL) called AdvocateCare.

For example, HMO author and lecturer William DeMarco said, "This is not an accountable care organization as the shared savings formula and results of quality improvement are put on the back burner in favor of replacing revenue lost in inpatient care," in an ACO Watch blog post.

Despite AdvocateCare declaring early successes with hospital admissions per member dropping 10.6 percent and emergency department visits decreasing 5.4 percent, according to Kaiser Health News, DeMarco said true ACOs aren't just about waste reduction. "Bundled payment by itself will not improve care or make providers remove waste from the system, rather providers will merely try and recover what they were [losing] by delivering preventable and avoidable care," he said.

The definition of ACO certainly is expanding--for better or for worse. As providers and payers join forces to collaborate care, they may be using the catchphrase but missing the point about quality.

In an Hospital Impact blog post, although not specifically related to ACOs, Thomas Dahlborg recalled when a CEO of a large hospital said he didn't have time to focus on quality improvement because of financial pressures. "Quality improvement focused on quality of care? I don't have time to focus on quality of care. I need to focus on improving efficiencies and revenue generation if I am to keep my hospital open. That is my focus. Care quality must take a backseat for now," the CEO said.

Likening them to "zombies," Dahlborg said providers are on autopilot.

"Care quality taking a backseat to fiscal pressures? It's another example of a caring, passionate, mission-driven healer/administrator being transformed by the broken healthcare system (with its misaligned financial drivers and intentions) into a zombie-like state with a limited focus on the bottom-line," he wrote.

For more information:
- read the ACO Watch blog post
- here's the Hospital Impact blog post

Related Articles:
'Largest commercial ACO' earns early results
Blue Shield forms new ACO with hospital, docs
Atrius CEO Interview: Inside a Pioneer ACO
From Volume to Value: Cigna's collaborative accountable care programs

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