Health Care Thoughts: Accountable Care "Smackdown"</

by Tom aka Rusty Rustbelt

Health Care Thoughts: Accountable Care “Smackdown”

The American Medical Group Association represents about 400 very large and sophisticated multi-specialty physicians groups, such as the Cleveland Clinic group and Intermountain (Utah) group.

The Obama administration had counted on these groups to be the first to create Accountable Care Organizations (ACOs), starting with Medicare ACOs in 2012 and then moving to full service ACOs. These groups were more likely to have the huge resources necessary to start an ACO.

On Wednesday the group announced 90% of its members would not participate, because the draft regulations issued March 31st were too prescriptive, too operationally complex, the move to risk sharing is too quick, the gatekeeper and risk management capabilities too much, and the time line too short. The AMGA consensus is the chance of success is close to zero, so why waste resources.

(see my post of 4/6/11:

Not to pat myself on the back, but I just finished two papers with essentially the same comments. I’m not that smart, the flaws are just so terribly obvious to anyone with operations or insurer/risk management experience.

If the big 400 cannot chew through this and come up with a workable plan, neither will other physician groups. Based on recent conference attendance many provider organizations are taking the slow down approach.

It appears today only very large very integrated systems owning all of the necessary providers will be in the first wave. This could change for the better, but I doubt it. This could change for the worse though.

Not enough ACOs, no significant cost savings with quality improvement, no deficit improvement, train wreck.