No word, as yet, from Medicare chief Dr. Donald Berwick on criteria for accountable care organizations. A new paper from the policy outfit RAND Corp. underscores the daunting task federal officials face as they attempt to balance financial incentives for providers to curb spending against adequate protection of patient safety.
Incentives versus safety
Hospitals and doctors may form groups to manage Medicare patients' medical care and costs though accountable care starting next year under the health reform law. Authors of the RAND report, under contract by the National Qualify Forum, reviewed performance measures and potential pitfalls for 90 payment methods and proposals.
Investigators also proposed measures to better tie payment to performance and protect against “unintended adverse consequences, such as avoidance of some high-risk or high-cost patients by providers, other barriers to access, and underuse of evidence-based services.” Among accountable care groups, the risk for such consequences appears significant, the report said. Risk adjustment for specific conditions would help offset potential financial incentives that work against costly patients, the authors wrote, as would process and safety measures, among others.
Medicare will also need a wide variety of measures to test accountable care across multiple settings, the report said. Medicare's most notable test of accountable care, the Physician Group Practice Demonstration, was limited to diabetes, congestive heart failure, coronary artery disease and preventive care, the Rand report said. Authors suggested a few possible places to begin: measures used by health plans and integrated delivery systems, as well as measures of health information technology use.
Perhaps we'll find out shortly whether Berwick agrees?
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