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VIEWPOINT

Health Care Delivery System Reform

Accountable Care Organizations

James T. Dove, MD^_*,_*, W. Douglas Weaver, MD and Jack Lewin, MD

^_* Prairie Cardiovascular Consultants, Southern Illinois University School of Medicine, Springfield, Illinois
The Henry Ford Heart & Vascular Institute, Detroit, Michigan
American College of Cardiology, Washington, DC

Manuscript received July 6, 2009; revised manuscript received July 22, 2009, accepted July 27, 2009.

^_* Reprint requests and correspondence: Dr. James T. Dove, Prairie Cardiovascular Consultants, Ltd., 619 East Mason Street, Suite 4P57, Springfield, Illinois 62701 (Email: jdove{at}prairieheart.com).

Health care reform is moving forward at a frantic pace. There have been 3 documents released from the Senate Finance Committee and proposed legislation from the Senate HELP Committee and the House of Representatives Tri-Committee on Health Reform. The push for legislative action has not been sidetracked by the economic conditions. Integrated health care delivery is the current favored approach to aligning resource use and cost. Accountable care organizations (ACOs), a concept included in health care reform legislation before both the House and Senate, propose to translate the efficiencies and lessons learned from large integrated systems and apply them to nonintegrated practices. The ACO design could be real or virtual integration of local delivery providers. This new structure is complicated, and clinicians, patients, and payers should have input regarding the design and function of it. Because most of health care is delivered in the ambulatory setting, it remains to be determined whether the ACOs are best developed in parallel among physician practices and hospitals or as partnerships between hospitals and physicians. Many are concerned that hospital-led ACOs will force physician employment by hospitals with possible unintended negative consequences for physicians, hospitals, and patients. Patients, physicians, other providers, and payers are in a better position to guide the redesign of the health care delivery system than government agencies, policy organizations, or elected officials, no matter how well intended. We strongly believe—and ACC has proclaimed—that change in health care delivery must be accomplished with patients and physicians at the table.

Key Words: health • education • labor • pensions • Centers for Medicare & Medicaid Services • accountable care organization

Abbreviations and Acronyms   ACC = American College of Cardiology   ACO = Accountable Care Organization   CMS = Centers for Medicare & Medicaid Services

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