Perspectives on accountable care organizations


Call me a cynic, but I’ve been around long enough to see the government play its passive aggressive games in the healthcare arena and I personally don’t like them as a “partner” -- silent, express or implied.

Early in the managed care wars I saw the creation of the private hospitalist group and their altruistic attempts to partner with hospitals to reduce overall healthcare costs. Their early attempts to share with the hospitals in the cost savings were met with the ire of the Office of the Inspector General, which ruled such arrangements were evil and prohibited them as disguised kickbacks. OIG later acquiesced that certain arrangements were acceptable within certain safe harbors.

Then came the ambulatory surgery center (ASC). Doctors created these entities to gain more access to operating suites and better control over OR staffing and sterile conditions of the suites. They also wanted to better serve their patients and be more cost efficient.  Some say the doctors did this to "cherry pick" the profitable procedures from the hospital’s menu, thereby reducing the hospital’s ability to make a profit from such procedures. 

After several years of profitable operations, the Centers for Medicare & Medicaid Services (CMS) reduced ASC reimbursement by one-third – using the fact that ASCs had proven procedures could be performed for approximately one-third less than in a hospital setting as the rationale.

Now comes the ACO concept with great hopes of physician/hospital collaboration (among other things) and promises of additional remuneration to all that can reduce costs via incentives based upon those healthcare cost savings. Do you really believe that CMS will not reset the bar to coincide with any savings generated by those trying to play by the rules and do the right thing? Their history in both similar and analogous situations belies what is just below the surface. 

Like Yogi Berra said so many years ago, "It's déjà vu all over again."

mcguinnessTom McGuinness, CPA, CVA, is is one of the founding partners of Reimer, McGuinness & Associates, P.C. He can be reached at .

Tom, unfortunately I concur with you on several of these fronts. It has become apparent that physicians cannot afford to sit idly by and let things happen to them without taking some form of action to help improve their own income and quality of life. With declining reimbursements and increasing expenses, today’s physician business owners are looking for alternatives to joining or, rather, being acquired/employed by the hospital systems.

The ACO concept may provide them with such an alternative. We will have to take a wait-and-see approach for a while longer to understand if the ACO model will be a successful one. Many of our peers are skeptical like you. In the interim, I will be hopeful that the term "accountable" will have actual meaning for CMS and those that participate in these organizations. Then, and only then, will change have a chance to be implemented. Time will tell. It’s too bad that the term accountable cannot be applied to the many other aspects of our health system. 

Marc H LionMarc H. Lion, CPA, CFP, is the founding member of Lion & Co., CPAs LLP, an accounting and consulting firm. He can be reached at .

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