Health systems and physician groups that have made investments to improve healthcare quality and efficiency have not seen an immediate economic case for the activities, which are at the center of a widely anticipated Medicare payment pilot included in the health reform law, according to a newly released review of seven organizations.
Business case for ACOs weak: report
The National Institute for Health Care Reform, a not-for-profit group founded by the United Auto Workers and U.S. automakers, funded the study of healthcare providers with existing quality and efficiency efforts that many other providers may adopt to create proposed accountable-care organizations. Starting in 2012, accountable-care organizations may be eligible for bonus Medicare payments based on performance and cost control.
"Although some noted ACO incentives or enhanced payments for patient-centered homes in the future might improve the business case for these activities, many acknowledged that the economic and market rewards may not materialize for a long time, if ever," according to the report, which was conducted by the Center for Studying Health System Change.
Researchers interviewed 34 people at or affiliated with several organizations: the Billings Clinic, Billings, Mont.; Carilion Clinic, Roanoke, Va.; Physician Health Partners, Denver; ProHealth Physicians, Farmington, Conn.; Sharp HealthCare, San Diego; UniNet, Omaha, Neb.; and Westshore Family Medicine/Mercy Health Partners, Muskegon, Mich. Organizations used reserves or grants to pay for additional nurses, information technology investments and other staff to coordinate patient care, according to the report.
The Billings Clinics was one of 10 organizations to participate in what is widely regarded as Medicare's model for accountable-care groups, the five-year Physician Group Practice demonstration, which produced mixed results, the report noted.
No more than half of the participants earned financial bonuses in each of the pilot's first four years.
"None of the organizations indicated positive return on investments related to improvement activities," according to the report. Other challenges to initiatives were staff resistance to change; potential productivity disruptions; and inaccurate data and privacy concerns associated with using information technology.
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