Chris Van Gorder, CEO and president of San Diego's Scripps Health, says attempting to launch something as complicated as an ACO in such uncertain times is going to intimidate a lot of healthcare executives "who already have a lot on their plate."
"Don Berwick and CMS talked about eight new programs they just rolled out in the last few weeks, with more coming. They are very excited about it. From my perspective I'm saying 'Good God. Let us absorb some of this,'" Van Gorder said.
"Every time they come out with a new program we have to take the resources to analyze it, figure out how they interface with each other, which ones we want to participate in, he added. "While I applaud their innovation and creativity, it is actually calling a lot of administrative stress and cost as we are sitting there trying to analyze which direction we should take our healthcare system."
With so much to contemplate, Kaufman says ACOs will fall to the bottom of the priority list for a lot of providers.
"I sent a letter to CMS and told them 'You are inundating us with innovation,'" he says. "The same hospitals that are contemplating this are implementing meaningful use IT systems, for both inpatient and outpatient, and having to prepare for ICD-10, and having to prepare miracles and cure people, all at the same time. You have to pick and chose which one of these is going to have legs over the long term and which has the greatest potential for downside, and I think the ACO is that."
Not everyone is down on the prospects for ACOs. David Spahlinger, MD, an internist and senior associate dean at the University of Michigan Medical School, called removing the downside risk in the final rule "a game changer" that should be well received by physicians.