Leah Binder in Accountable Care News: "Pioneer ACOs"

June 21, 2013

Thirty-two health systems are designated by CMS as "Pioneer Accountable Care Organizations (ACOs)."

Here's my definition of a pioneer: Laura Ingalls Wilder, author of the Little House on the Prairie series of books, and one of my heroes. She spent her childhood (more than a century before mine) in a family of itinerate farmers and foragers, traveling in their covered wagon through uncharted, often dangerous territory.

The 1970s TV series never quite captured the downside of life on the prairie, but the books did and that's part of what made them such classics. Pa couldn't have a bad day and skip the chores or the family would starve or freeze to death. Ma prepared the meat from Pa's kill at the hunt that day, and she spun the fabric to sew the family's clothing. When they set out on their covered wagon for a new destination, they didn't have a road map or even a road. They relied on the stars in the sky and their own determination. Still, they laughed and danced, and they always seemed to be looking for the next journey and the next adventure.

Let's contrast the pioneering Ingalls family with the 32 so-called "Pioneer ACOs." In a March 2013 letter written to the Center for Medicare Services (CMS), these modern-day pioneers of accountability complain they are being treated unfairly, and if it doesn't stop, they won't be pioneers anymore. As CMS prepares to start paying them according to their performance on identified measures, the letter asserts that some of the measures have "flat percentage benchmarks without anchoring methodology." Translation: CMS is imposing very high standards for quality not scaled according to current national hospital performance. Apparently, these "pioneers" expect to accomplish nothing different from what their non-pioneer colleagues in the rest of healthcare accomplish...

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