Rain poured down on San Francisco during the entirety of the sixth National Pay for Performance Summit last week, and apparently washed away the headline topic.

Instead of P4P, the hot topic at the conference, held at the Hyatt downtown, went by another acronym: ACOs. All 624 attendees—and 50 more watching online—seemed to be here to learn about so-called accountable care organizations. And most were waiting with bated breath for forthcoming proposed rules on ACOs, expected at any moment from federal regulators.

“Look at what they've done so far,” said Tom Williams, executive director of the Integrated Healthcare Association, an Oakland, Calif.-based group hosting the summit and one of the premier groups focused on healthcare quality and efficiency. He was referring to the Obama administration. “Only nine pages out of one thousand in the health reform law were about ACOs. And look what it has inspired in the private sector.”

It seems every day there's another announcement from another health system about an ACO pilot project.

Richard Gilifillan, acting director of the CMS, addressed attendees via phone about the administration's wish to encourage experimentation of new payment models. Gilifillan spoke mostly in metaphors.

“We want to create a wildfire of innovation in this country,” he said.

“This is a primordial soup of innovation,” he added.

Let's “stir the pot” and get ideas flowing, he encouraged.

When pressed about the regulations, he reverted to “no comment.”

Some were less than impressed with the CMS.

“If there are wildfires of innovation going on, they (the CMS) are the firemen coming behind to put them out,” said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute in Newtown, Conn., which develops and deploys pay-for-performance and alternative payment models.

Innovation is coming from the private sector, and the CMS is “absent at this point,” de Brantes said during a panel discussion.

“I don't know what the hell they are doing in Washington but someone needs to go down there and kick their asses,” de Brantes concluded, to loud applause and cries of “Here, here!” from several in the audience.

De Brantes

Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform in Pittsburgh, Pa., said that payers and providers shouldn't wait for the CMS to act on payment reform. "We've got to get Medicare there, but we need to do this on a local level," Miller urged the audience.

Peggy O'Kane, president of the National Committee for Quality Assurance, urged some caution.

“ACOs with shared savings are kind of a nice idea,” O'Kane said. “But I don't think we will get where we need to be until we get payment reform.”

O'Kane added that payers and providers shouldn't be the only ones to benefit from better care. “Some ACO savings should go back to the patient, maybe in the form of benefits,” she said. “It is an ethical imperative.”

A pressing concern is that patients simply won't like ACOs, or will think the model is merely dressed-up rationing.

“Consumers out there are very concerned about a lack of choice,” said Jeffrey Selberg, chief operating officer at the Institute for Healthcare Improvement in Cambridge, Mass.

Market consolidation is another “well-founded” fear, Selberg added.

Pay for performance measures won't be thrown by the wayside, said Williams. Instead, they can help drive quality and boost public confidence in alternative payment models, he said.

Barry Arbuckle, president and CEO of MemorialCare Health System in Fountain Valley, Calif., said hospitals need to jump into the outpatient side to control quality of care and reap shared savings from alternative payment models. MemorialCare recently affiliated with four Southern California physician groups.

“Community health systems need to be able to compete,” he explained in an interview.

Arbuckle isn't one waiting on federal regulations on ACOs, saying they have “no relevance” to the private sector. But he added that does have a meeting scheduled for next month with Gilfillan and other CMS officials.

Rebecca Vesely reports on healthcare payers and purchasers. She covers regional healthcare business news in Alaska, Arizona, California, Hawaii, Oregon and Washington.