Special report: ACOs and imaging

by Brendon Nafziger, DOTmed News Associate Editor | October 21, 2010
One of the most talked about new trends in health care, accountable care organizations promise to contain exploding health care costs and improve patient care. But imaging industry experts worry that unless properly worked out, the ACO model could dry up already parched capital equipment budgets and unfairly burden radiologists.

Further, some critics say we've seen this movie before, and it ends badly.

While still largely lumps of unmolded clay on the bureaucratic workbench, ACOs are starting, slowly, to take shape. Pilot projects are beginning to emerge in the run-up to January 2012, when the Centers for Medicare and Medicaid Services will start awarding contract bids for ACOs voluntarily started by providers.

But a lot has to be ironed out before then. Proposed rules from CMS likely aren't arriving for a few months, and exact reimbursement schemes are still mostly a matter for conjecture. Plus, experts still have to ensure ACOs are completely legal and don't run afoul of antitrust laws.

Nonetheless, the gist of the ACO model is to embody the "Triple Aim" concept promoted by the Institute for Healthcare Improvement, founded by current CMS head Donald Berwick: improving patient experience and the health of a defined population, while controlling per capita costs.

Or as the IHI's website puts it, "the best care, for the whole population, at the lowest cost." Simple, right?

In essence, ACOs treat a network of providers around a hospital as a virtual organization managing a set patient population. The idea is to reward the providers for coordinating care and controlling costs, and hitting certain outcomes, such as keeping chronically ill patients healthy and out of the emergency room.

One method is capitation, in which ACO-associated providers get a fixed budget to treat a patient population, and only qualify for yearly increases if they stay under budget. Or, in other models, providers aren't penalized if they go over budget, but if they stay under, they get to pocket some of the savings.

But aggressive cost-curbing measures like capitation are what make some in the imaging industry nervous, as it's not clear exactly how this will press upon imaging utilization or capital equipment purchases.

Jeff Goldsmith, president of health care forecasting firm Health Futures Inc. and an ACO critic, summed up the uncertainty succinctly.

"Radiology and imaging will be disproportionately contributing to savings," he told DOTmed News in an interview, "and it's not clear if they will be disproportionate receivers of savings."