The head of a medical technology group is asking whether the new accountable care organizations will chill medical innovation by promoting a “cheapest is best” approach to health care.

The head of a medical technology group is asking whether the new accountable care organizations (ACOs) will chill medical innovation by promoting a “cheapest is best” approach to health care.

Stephen Ubl, president of AdvaMed, Washington, talks about ACOs in a blog on Health Affairs, an academic journal that focus on efforts to deliver and pay for health care.

An ACO is supposed to be a vehicle for paying teams of health care providers to provide and manage care for whole patients, instead of paying for care one service at a time.

Section 3022 of the Patient Protection and Affordable Care Act (PPACA) requires Medicare to set up a Medicare Shared Savings Program that will promote use of Medicare ACOs starting in 2012.

Medical societies have argued that health insurer concentration helps insurers dominate physicians in an unfair way.

Health insurers traditionally have argued that they need substantial market clout to bargain

for reasonable prices from physicians and hospitals. They have expressed concerns that poorly structured ACO programs could lead to higher health care prices rather than lower prices.

Ubl says he believes the real danger is that ACOs could lead to stinting on care that could make a real difference in the length and quality of patients’ lives.

“While meeting the quality measures may be a necessary condition for quality care, it is certainly not a sufficient condition,” Ubl says. “These quality measures do not generally measure outcomes and there are vast areas of clinical practice which are not addressed at all. To cite just a few examples, there are no measures for treatment of cancer. There are no measures for treatment of severe arthritis. There are no measures for treatment of osteoporosis. There are no measures for treatment of chronic pain.”

Policymakers could prevent arbitrary stinting by having independent monitors oversee the ACOs, Ubl says.

Patient outcome and cost measures also need to take into account benefits that may accrue over many years, such as a 25-year period, rather than a 1-year period or some other short period, Ubl says.

- Allison Bell

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