Accountable Care Organizations Complain Federal Metrics for Success Are Unfair

One of the cornerstones of the Patient Protection and Affordable Care Act, the “accountable care organization” (ACO), has failed to live up to expectations in its first year, Kaiser Health News reports.

But the problem, according to 30 of the 32 pioneer healthcare providers who are piloting the concept, is that the metrics for measuring their success are faulty. The pioneers have sent an ultimatum to the Centers for Medicare and Medicaid Innovation: “Pioneers need to know before April 2, 2013, if you accept our recommendations, so that we can make informed decisions regarding our ongoing participation.”

According to the pioneers, 19 of the metrics “had too little data behind them and were therefore unfair, unreasonable and even arbitrary,” KHN reported. The combined group of ACOs has recommended that CMMI wait until it has more data and establish metrics for defining quality of ACOs beginning in 2014.

The pilot ACOs are compensated based upon their performance against the quality metrics. If they exceed expectations, they receive a bonus; if they fail to meet the quality targets or spend too much on care, they are penalized.

Because President Barack Obama has publicly touted the ACO experiment, healthcare industry pundits believe that the perceived flawed metrics will be corrected to everyone’s satisfaction, KHN reported. “I think there’s gonna be a lot of closed door meetings and heated phone calls,” Erik Johnson, vice president of the consulting firm Avalere Health, told KHN. “But eventually, everyone will come out holding hands.”