NEJM: How Will ACOs "Keep Score" of Physicians' Pay?
Despite the implementation of ACOs, many hospitals will continue to use fee-for-service payments as a way to "keep score," or determine who has earned what portion of payments, according to the report. This works against the very design of the ACO program, but there is not a replacement method of score-keeping built into the ACO concept.
Further, primary care physicians are likely to shoulder the largest burdens of ACO implementation since they will need more resources to properly manage the health of entire populations, according to the report. These resources include care managers and other personnel to coordinate and manage care, and new processes or tools to ensure quality measures are met.
The report concludes that "ACOs that incorporate global incentives but continue to keep score using fee-for-service payments will face serious challenges as they attempt to place increasing burdens on the already-stressed primary care system without providing additional resources."
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