The Everett Clinic has done outstanding lean work over the years showing reductions in cost of care and improved quality. Why aren't they pursuing the ACO model?
This according to Politico a Washington D.C. based electronic policy publication:
The Everett Clinic, which has been participating in Medicare’s accountable care organization demonstration project since 2005, doesn’t plan to pursue certification as a full-blown ACO
Officials at the clinic explain that their strategy is to move patients out of traditional Medicare and into the Medicare Advantage managed care program.
“I think it’s fair to say we’re very disappointed with the ACO rule,” Mark Mantei, CEO of the Everett, Wash.-based clinic said.
The rule doesn’t do enough for “high-performing” clinics like Everett. In particular, there isn’t enough “financial reward” for attaining higher quality care, similar to what CMS created in the 5-star quality bonus program in Medicare Advantage. In short, the clinic has put lots of effort into improving care for its patients, but has seen “little potential return.”
— Retrospective attribution of patients and retrospective setting of cost targets are problematic. An ACO needs to be able to nimbly act when it knows what patients are in the system, to quickly employ care coordination treatment. The proposal doesn’t account for this, Mantei said.
— Poor “coding” for treatment that didn't reflect how sick Everett’s patients are continues to penalize the clinic. The analysts at Everett explained that the limitations in the rule on “risk adjustment” methodology are too great.
So, as I blogged yesterday high performing systems like ThedaCare and the Everett Clinic are finding little reason to participate in ACOs but many reasons to participate where better value is rewarded such as the Medicare Advantage bonus pool. I would also add to that the Physician Quality Reporting Initiative(PQRI), the Electronic health record bonuses through the Office of the National Coordinator and hopefully a new avenue related to CMS's safety initiative reported on this blog a couple weeks ago with more information to come next week.
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