Accountable care organizations might cut costs, but challenges remain

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Automatic 2% Medicare cuts begin
Automatic 2% Medicare cuts begin
A new report suggests that accountable care organizations can lead to better health for beneficiaries and lower costs for healthcare participants.

The Commonwealth Fund Commission released 10 recommendations to help the spread of ACOs, including the inclusion of primary care physicians. The full report, High Performance Accountable Care: Building on Success and Learning from Experience, is here.

But details on ACOs — and whom they would benefit most — are still unclear. ACOs, set to begin in 2012, are designed to act as incentive programs, pushing healthcare providers to provide high-quality care and keep patients out of the hospital or from being readmitted. Guidelines for them were issued March 31 and nursing facilities are eligible to take part.

A recent report from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative questions whether ACOs would help medically underserved communities. The authors said 1.4 billion Medicare beneficiaries who receive primary care from federally qualitative health center (FQHCs) could not be in a health-center formed ACO, and that rural Medicare recipients would also suffer.

"CMS has attempted to craft a modest financial incentive in order to encourage ACOs to overcome the effects of its interpretation and include FQHCs and RHCs. But the incentive is unworkable and—more importantly—cannot overcome the impact of a policy that simply put, states that millions of medically underserved patients don't count when calculating shared savings,” said Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy and lead author of the study.