Accountable care organizations are growing in number but are they meeting their goals?

Some time ago, a man I know underwent a series of medical tests for sudden, unexplained symptoms. It began with atrophy of the muscles in his left leg, weight loss, and fatigue. While he never received a definitive diagnosis, specialists at a well-known hospital linked his symptoms to a problem with his pituitary gland. Over a year later, he received an unrelated diagnosis of prostate cancer and was scheduled for routine surgery at a different hospital. He underwent presurgical tests and on the given day was prepped for surgery. But just prior to being rolled into the OR, the surgeon cancelled the procedure. Apparently, despite examining the patient several times and reviewing his history, the first time the surgeon actually saw the MRI of the patient’s brain was on the morning of surgery. Whatever he saw made him determine the patient was not a candidate for surgery, after all.

This incident caused undue waste in the health care system. The two health care institutions did not communicate effectively. This led to unneeded pre-surgical tests and a waste of valuable staff time. What’s more, the whole ordeal caused the patient unnecessary psychological trauma.

Accountable care organizations (ACO) were designed precisely to eliminate this kind of fragmented, disconnected care. Coordinated care aims for better communication and less confusion. Here is how the Centers for Medicare and Medicaid Services (CMS) state it on their Web site: “The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.”

The ACO model is still new, but it’s growing strong according to CMS. In early April, CMS announced the first 27 accountable care organizations under the new Medicare Shared Savings Program. These 27 Shared Savings ACOs will serve an estimated 375,000 beneficiaries in 18 states. Moreover, as of April 1, there are a total of 65 organizations participating in one of the various Medicare shared savings initiatives. This includes the 32 Pioneer Model ACOs that were announced in December 2011 and the six Physician Group Practice Transition Demonstration organizations that began in January 2011. Presently, more than 1.1 million beneficiaries are receiving care from providers now officially known as accountable care organizations.

Our cover story, “Triple Aim” by Renee Diiulio, explores the role radiology is playing in helping accountable care organizations meet their key objectives. Several clinicians from Pioneer ACOs—the early adopters of coordinated care—share their insights. However, CMS declined an interview for this article. We wanted to learn more about what specifically radiology will be measured on in the ACO setting. (For example, is the goal fewer redundant tests? Is it lower utilization of imaging in general?) A spokesperson from CMS told our reporter that they weren’t ready yet to drill down to a level where they can talk about imaging and any perspective the organization would provide would be a very general one.

ACOs were designed to transform a broken health care system. They are charged with improving care and reducing costs. That’s a tall order. While radiology’s role in helping achieve those goals is still evolving, one thing is clear. We can’t afford to fall short.

Marianne Matthews

Marianne Matthews