Did Push for ACOs Ignore Basic Math?

John Marcille

We tiptoe into the waters when fishing for a metaphor. That’s especially true when the fish sought is called complementary and alternative medicine. Like the barkeep Rick in Casablanca, we will remain “carefully neutral” by not naming specific therapies. We will only say this: Sometimes we want so much for things to be true that we will ignore science, and even common sense, that suggest otherwise.

Which leads us to accountable care organizations, the subject of our cover story. We have followed the life of ACOs from theory to enactment of the Affordable Care Act. All the while, we’ve included voices that said (to make this a true surf-and-turf offering), “Where’s the beef?”

Even if ACOs worked the way proponents want them to, even if providers could get a handle on actuarial risk (with or without the help of plans) or costs, the math just didn’t seem to add up.

There are about 5,800 hospitals, and 780,000 physicians in the United States. As Alice Gosfield, one of our editorial board members, puts it: “They are not all going to be in ACOs.”

That’s not the only thing that doesn’t add up. Providers that so want ACOs to become reality now keep a wary distance after the Centers for Medicare & Medicaid Services announced the regulations that would govern these entities. They don’t see how they can make a profit and improve care by adhering to 65 mandatory quality measures.

What isn’t mandatory is participation in ACOs. All of a sudden, providers are checking their watches and jingling their car keys. They want out of here. The voices that we’ve featured all along, like the ones in this issue’s cover story, aren’t saying “I told you so” in so many words. Still, we have a feeling that ACOs are not ready for prime time.

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