Here are five things to know from the report:
1. The detractors, including Kevin Schulman, MD, of Duke University School of Medicine and Harvard Business School, and Barak Richman of Duke University School of Law, say there haven't been adequate cost-savings and efficiencies. The early published findings suggest "less-than-ideal" efficiencies from ACOs.
2. The Pioneer ACOs show savings in cost of care for CMS in 2012 — 1.2 percent. However, after accounting for bonus payments the cost savings were just 0.4 percent. Forty percent of the participating sites didn't participate the second year.
3. The ACO model has accelerated the trend of hospitals acquiring physician practices, according to the detractors, and consolidation can lead to price increases with one institution having a monopoly on the market. In local markets without competition, prices are 15.3 percent higher than in competitive markets.
4. Proponents of the ACOs including Zirui Song, MD, of Massachusetts General Hospital and Elliott Fisher, MD, of Dartmouth Institute for Health Policy and Clinical Practice feel it's too early to gauge the success of ACOs; reversing course would be a mistake since evidence on quality is promising even if cost-savings haven't been realized.
5. The Blue Cross Blue Shield of Massachusetts Alternative Quality Contract and Medicare beneficiaries have reported quality improvement. Medicare beneficiaries have also reported better access to care and there are higher subjective ratings of overall quality for patients with multiple chronic conditions.
6. The proponents feel a gradual transition to reasonable risk-bearing models can have greater financial rewards for physicians. They also propose transitioning to enterprise liability so the ACO is liable for malpractice claims instead of individual physicians.
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