It's no secret: They are cool to ACOs

The view from the hall, again...

It's May in New York, so I wandered over to the yearly Non-Profit Health Care Investor Conference put on by the Healthcare Financial Management Association, the American Hospital Association and Citigroup.

Once again, I found myself outside a closed door in an overly air conditioned hotel hallway waiting for health system executives, investors and bankers to emerge, briefly, before disappearing again.

My invitation extends as far as the hall.

I am not allowed into sessions where top executives from some of the nation's wealthiest health systems review their finances, operations and strategic plans and field questions from analysts and bankers.

So I wait. I comb through revenue projections, debt details and other snippets included in overview materials distributed by not-for-profit health systems. Or I catch an unsuspecting soul too distracted by a smart phone or Blackberry to see me coming. Once the doors open, I plow my way into an animated conversation. Or I pick up my pace to keep up with an executive moving briskly toward another session or a waiting cab headed for the airport.

Not surprisingly, talk among the attendees at the Hilton New York returned again and again to accountable care. Medicare's proposed plans to award bonuses or fine providers based on quality performance and health spending targets found little love among the healthcare executives and insiders at the conference.

“I think you're hearing a lot of disappointment,” with draft rules released by agency that oversees Medicare, said Richard Umbdenstock, AHA's CEO and president. He readily acknowledged the challenge that faced federal officials as they sought to devise parameters for the untested model. Yet delays releasing the draft and frustration with the proposals have dampened hospitals' enthusiasm, Umbdenstock said.

Robert Henkel, chief operating officer and president of healthcare operations for Ascension Health, the nation's largest private not-for-profit health system, described the proposed Medicare rules as “unworkable” and questioned whether any providers would attempt it.

Meanwhile, executives appeared less pessimistic about efforts among private insurers and health systems to link more hospital and physician payment quality performance and healthcare costs.

Katherine Arbuckle, chief financial officer of Bon Secours Health System, said the 13-hospital system would “not likely” participate in Medicare's proposed accountable care experiment. She added that the Marriottsville, Md.-based system is developing a private-market effort.

Nonetheless, health systems had more confidence than investors in the ability of accountable care organizations to bolster medical care, improve health and reduce costs, judging from an informal survey during the first day. Forty-three percent of health systems said ACOs could deliver on quality and efficiency, while 34% of investors agreed.

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