The Case for Enrolling High-Cost Patients in an ACO
Though accountable care organizations (ACOs) are increasingly important to American healthcare, ethical inquiry into ACOs remains in its nascent stages. Several articles have raised the concern that ACOs have an incentive to avoid enrolling high-cost patients and, thereby, have an incentive to deny care to those who need it the most. This concern is borne out by the reports of consultants working with newly formed ACOs. This paper argues that, contra initial appearances, there is no financial incentive for ACOs to avoid enrolling high-cost patients.
KeywordsAccountable care organizations Bioethics Medical ethics Patient Protection and Affordable Care Act High-cost patients Healthcare expenditures
- Centers for Medicare and Medicaid Services. (2011). 42 CFR Part 425. Medicare program; medicare shared savings program: Accountable care organizations. http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf.
- Centers for Medicare and Medicaid Services. (2016). Medicare shared savings program quality measure benchmarks for the 2016 and 2017 reporting years. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-QM-Benchmarks-2016.pdf.
- Centers for Medicare and Medicaid Services. (2017). Medicare shared savings program accountable care organizations performance year 2015. https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/x8va-z7cu.
- Centers for Medicare and Medicaid Services. (2017). Accountable care organizations. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO.
- Greenwood, M. (2017). Pence reaffirms plans to "repeal and replace" ObamaCare. http://thehill.com/policy/healthcare/317688-mike-pence-gop-will-still-repeal-replace-obamacare.
- Muhlestein, D. (2015). Growth and dispersion of accountable care organizations in 2015. Health Affairs Blog. http://healthaffairs.org/blog/2015/03/31/growth-and-dispersion-of-accountable-care-organizations-in-2015-2/.
- Ramsay, L. (2016). Press release: Management of ethical issues will make or break ACO’s. Retrieved April 17, 2016 from http://www.bioethicsinstitute.org/media/press-releases/press-release-management-of-ethical-issues-will-make-or-break-acos.
- RTI International. (2016). Accountable care organization 2016 program quality measure narrative specifications. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2016-ACO-NarrativeMeasures-Specs.pdf.
- Snell, K. & DeBonis, M. (2017, February). Two top republicans open to repairing Obamacare ahead of repeal. https://www.washingtonpost.com/powerpost/two-top-republicans-open-to-repairing-obamacare-ahead-of-repeal/2017/02/02/33d20ab4-e987-11e6-80c2-30e57e57e05d_story.html?utm_term=.b936ecd1bde5.