Medicare needs mechanisms for controlling fee-for-service billing growth or volume, and improving quality, researchers with the Medicare Payment Advisory Commission told commissioners during MedPACs March meeting. Accountable-care organizationsa model that lets hospitals and physicians share joint responsibility for quality and cost of care delivered to patientsshow potential for controlling volume growth and improving care coordination, the researchers said.
Two paths for establishing ACOs were presented, a voluntary model whose design would be contingent on bonuses and voluntary participation, and a mandatory model, which would tie bonuses and penalties to overall Medicare spending. According to MedPAC researchers, the mandatory model would offer stronger incentives for providers to organize themselves and to control volume. A voluntary ACO would have to be attractive enough to providers to get them to participate, the researchers stated.
Commissioners had concerns about making such an organization mandatory, claiming it would fuel concerns among hospitals and doctors about potential lost revenue. In addition, these models dont offer a clear role for the Medicare beneficiary, commissioners stated. The beneficiary would need some incentive to stay in the ACO. Thats the biggest obstacle this care model would face, MedPAC Commissioner Nancy Kane said.