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Band-Aid or Solution? Experts Debate the Future of Accountable Care

Within the complicated puzzle that is American health care in 2012, a great deal rests on the idea of greater accountability throughout the system. That goal is a centerpiece of The Patient Protection and Affordable Care Act, signed into law by President Obama in 2010.

Proponents say enhanced accountability, administered correctly, will result in better patient care at lower cost. The law’s chief vehicle for arriving at this outcome is the creation of Accountable Care Organizations (ACOs).
 
ACOs are groups of health care providers who form an organization and agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.  
 
Whether they will work as advertised was the subject of 2012 symposium of The Journal of Contemporary Health Law and Policy, “Ushering in Accountable Care: Progress and Future under the Affordable Care Act,” held at Catholic University’s law school on Feb. 10.
 
Six invited experts traded analysis, ideas, and predictions over how ACOs will ultimately affect the nation’s health care system.
 
“As we test general ideas and attempt to bring them to scale, we won’t see uniform results,” said Douglas Hastings, (top photo)  chair of the board of directors of Epstein Becker & Green, P.C. Hastings is recognized as one of the nation’s leading experts on accountable care and value-based payment.
 
He noted that health costs and outcomes vary widely throughout the country, and said that many Americans who recall the failed attempts at greater accountability in the 1990s may be skeptical of today’s revised effort. The Supreme Court itself has agreed to hear a challenge to the constitutionality of the core of the 2010 law.
 
Regardless of political outcomes, “My view is that we have consensus” on the need to hold every component of the health care system to a more accountable standard, said Hastings.
 
           
 
But ACO’s will never be a cure-all, argued Thomas Scully (above left) senior counsel at Alston & Bird and former administrator of the Centers for Medicare and Medicaid Services. Scully, a 1986 alumnus of the Columbus School of Law, called ACO’s “a fundamentally good concept but only a tiny step in the right direction.”
 
“Reform is all about creating incentives for people to follow,” said Scully. He believes the current ACO model lacks sufficient financial incentives for doctors, insurers, or patients to adopt it.
 
“Are ACOs going to change the health care system? Not in my lifetime,” he predicted.
 
The four-hour symposium drew the attendance of a number of interested spectators, including four judges with the District of Columbia Office Administrative Hearings. They included John P. Dean, principal administrative law judge, Paul B. Handy, administrative law judge, Elizabeth Figueroa, administrative law judge, and Claudia C. Crichlow, administrative law judge.