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Reports on Inconsistencies in ACO Trials

ACOsSince they were established under the Affordable Care Act, Accountable Care Organizations (ACOs) have been lauded for their more effective patient care practices and greater Medicare cost reductions. However, according to a new set of federal healthcare data, ACOs do not always demonstrate the same degree of success—especially when it comes to managing diabetes and heart disease.

The news of inconsistent results across ACOs is confounding, particularly because it is one of the first results published using information taken from the first round of ACO programs. Though the country already seems to be putting a wild amount of faith in the success of ACOs, it is still only the first time these programs have been executed.

In order to record the effect ACOs have on the healthcare industry, the Centers for Medicare and Medicaid Services (CMS) set out to define 33 different quality measures and track how ACO providers perform in terms of providing preventative services, physician coordination, fend off adverse events, etc.

Measurement data from five of the 33 sanctioned quality care measurements was recently sent out in a press release that reported on ACO performance in the context of patients who suffer from diabetes and heart disease. The other 28 quality measures went unaccounted for, this being defended as a protective measure for a public who would not be able to understand the meaning of the numbers in such a complex system. Otherwise, CMS said, doctors who take on patients in more critical condition may be unjustly penalized based on an unfair representation of their quality measures.

Two additional factors may contribute to inconsistent data: patient compliance and accurate reporting on behalf of the healthcare providers. It was reported that on average only 75% of patients complied with orders to abstain from alcohol and tobacco use during treatment. One participating hospital admitted to a reporting error that skewed government data on ACO diabetes management.

Although ACOs met the goals set for them by Medicare at a rate of 65-75%, they also received lower quality measurement scores than the non-ACO population in a similar Medicare study that’s results were released at the same time.

Can the inconsistency of success be an attribute of the callowness of the ACO program? Even when considering the sophistication of the data collection methods that are so definitive of these new healthcare networks? Are ACOs just not turning out to be worth their hype? Or has CMS just not provided enough information for us to really understand the effect that the ACOs have had?

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Tom Prose