W. Rucker, MD, MS, MBA
We simply don’t know whether accountable care
organizations (ACOs) will work; the results aren’t in yet.
Several years ago, a
similar research project – funded by the Centers for Medicare & Medicaid
Services (CMS) and known as the Physician Group Practice Demonstration (PGPD) –
yielded minimal savings for all but one of the 10 participating medical groups.
Questions also arose regarding how much of the savings were true cost savings
rather than upcoding at the billing levels. Additionally, a large and
heterogeneous body of data over the last 20 years suggests that physician networks
that aren’t tightly managed tend not to generate significant savings.
Fully employed and integrated health care delivery
systems, such as Kaiser Permanente, Geisinger Health System, and the Veterans
Health Administration, have achieved significant savings under more fully
current capitated payment models – and with care models integrating specialty
care in an appropriate mix.
What will the future hold for ACOs? The Obama
administration and the CMS are under immense budget pressure to hold down Medicare
and Medicaid spending. The next best alternative to ACOs to hold down costs is
to bundle payments for services – paying physicians and hospitals by the
procedure and forcing health care providers to accept a set price and
prioritize what’s important. This action would force part of the spending cuts
back onto physician choice rather than having it set on a line-item basis by
CMS, as it does now with the annual Medicare Fee Schedule (MFS) updates for
every current procedural terminology (CPT) and DRG (Diagnosis Related Group)
payments can be bundled in countless ways for various packages of medical
services, ACOs remain the current signature initiative. ACOs are only beginning
to take hold in this country – expect many changes on the road to broader
Donald W. Rucker, MD, MS, MBA, is vice president and
chief medical officer of Siemens Healthcare USA, the healthcare division of
Siemens. A graduate of Harvard College and the University of Pennsylvania
School of Medicine with Board Certifications in Internal Medicine and Emergency
Medicine, Dr. Rucker holds a master’s degree in Medical Computer Science and an
MBA, both from Stanford. Dr. Rucker came to Siemens from Boston’s Beth Israel
Deaconess Medical Center, where he was the first full-time Emergency Department
attending, and from Datamedic Corp., where he co-developed the first Microsoft
Windows based electronic medical record. Dr. Rucker recently completed two
terms on the Board of Commissioners of the Certification Commission for
Healthcare Information Technology. He also practices emergency medicine in the
University of Pennsylvania Health System.