Newtown, CT – April 20, 2012
Sometimes, what's more important is who's not on a list than who's on it – Last week CMS released the list of the 27 initial organizations that have made the cut for the ACO Shared Savings program. This follows a list of 32 organizations that made the cut for the ACO Pioneer program launched by the Innovation Center. As such, in total, close to 60 provider organizations have decided to step up and become an integral part of the solution to the health care cost problem. And with the recent 32, the geographic diversity of these organizations is impressive and encouraging. From rural Georgia to rural Wisonsin, Northern New Hampshire to Southern Arizona, much of the country seems engaged. Much but far from all. And what's fascinating is that large and well-developed metropolitan areas that include respected hospitals and medical centers are AWOL. The noted exceptions are Partners Health Care in Boston and Montefiore in the Bronx, and kudos to them for stepping up to the plate. But apart from them, where are the others? NY Presby, absent. TJU, absent. Rush, absent. Advocate, absent. Vanderbilt, absent. UPMC, absent. Baylor, absent. In fact, none of the large hospitals or academic centers in NY, PA, IL and many other states are participating. In addition many of the blowhards – those that publicly claim to be ACOs while carefully refusing to take on any risks – are all sitting this out. This, to an extent, proves a point we've been making for a while: the status quo is very comfortable for many and only a loaded gun pointed to their heads will make them move.
What this means to you – The first lesson that CMS should learn from the ACO program is that there are certain cities and communities in the country where, apparently, Medicare fees, including GME credits and all the other adjustments to base fees, are far too generous and need to be made much less so. The next lesson is for private sector payers who have been listening to the song and dance from the blowhards and now need to seriously call them out. Some of them might still come onto the scene in the next batch of ACOs that get included in the CMS program, or in the CMMI Bundled Payment pilot, and in which case we will applaud their participation. But until then, we have to assume they have declared their colors. They have hoisted the skull and bones flag and stand defiant, preferring to pick the pockets of all who venture under their scopes and scalpels rather than actively participate in transforming US healthcare into a patient-centered, efficient and effective system. They've been raping and pillaging employers and their employees for years with absurdly high fees coupled with gag clauses, while pretending to deliver value. They're now revealed for what they truly are….pirates.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.