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2 ACO Experts, 2 Viewpoints, Too Much to Know

Karen Minich-Pourshadi, for HealthLeaders Media, May 31, 2011

A few drawbacks of the program, according to Kaufman:

  • The Patient: The Pioneer Program doesn’t offer providers the ability to penalize the patient for going out of network for treatment. Nor does it allow providers to know which patients they are treating are participating in the program.
  • Capital Investment: The amount of capital that needs to be invested in the infrastructure to set up an ACO is still high, which means most providers who want to participate in an ACO would need to affiliate with a hospital. “Most physicians can’t come up with the [approximately] $2 million they’d need on their own. All the Pioneer Program does is provide medical groups with a slighter easier way to buy in to a flawed business model,” says Kaufman.
  • Shared Saving Cap: There is a shared savings cap of 15% for the providers who participate in this program.

If you’re still not sure if the Medicare ACO or the ACO Pioneer Program sound like opportunities you’d like to pursue at your organization, the CMS is dangling one more carrot to encourage participation through the Advanced Payment Initiative.

“I think going to be helpful, and it’s important [to offer financial aid] but it doesn’t go far enough … there needs to be a loan authority,” says Lutes.

With 93% of American Medical Group Association members recently responding in a survey that they would not be participating in the Medicare ACO program, Kaufman says he views this initiative as an attempt by the government to spark interest and quell their own embarrassment.

“If they weren’t going to get participants, then they needed seed money to try to make it easier to get started,” he says.

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