Accountability? Heaven forbid!

At a recent talk, Dartmouth’s Elliott Fisher facetiously remarked that we cannot yet be sure whether accountable care organizations (ACOs) will actually be accountable, caring, and organized. Well, if some providers have their way, they certainly won’t be accountable.

This story by Jordan Rau in the Washington Post relates comments being made as Medicare writes its rules governing the ACOs. Here are some quotes:

[S]ome prominent doctor and hospital groups are pushing for features that some experts say could undermine the overall goal – improving care while containing costs. They’re seeking limits on how the quality of their care will be judged, along with bonus rules that would make it easier for them to be paid extra for their work and to be paid quickly.

Here’s the one I like best:

The Federation of American Hospitals, representing for-profit facilities, goes further, urging that ACOs be allowed to choose their patients. “Providers are better positioned than CMS to determine which of their patients would be appropriate candidates,” the federation wrote.

So, we are happy to be held accountable, but only if we get to choose which patients are part of our network.

And, how about this from the American Medical Association?

The medical association doesn’t want surveys of patient experiences to be used in evaluating ACOs.

Right. What do the patients know, anyway?

And from my soon-to-be-former hospital association:

In the dispute over financial incentives, the American Hospital Association is pushing CMS to let providers collect bonuses early on and in full rather than having some of the bonuses deferred as an added incentive to keep up the good work.

Collect bonuses before you earn them? Of course.

Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. Paul recently became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so. For the past three years he has blogged about his experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

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What are the main goals of the Chief Accountability Officer within a Healthcare System?


i think Jordan Rau work very good ..!!!i am really glad to ready this story …


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Paul, great observations as always! Your wisdom and insight will be missed at BIDMC.

John R. Graham

Dr. Fisher’s comment reminds me of what I learned in history class about the Holy Roman Empire. Namely, that it was neither holy, Roman, nor an empire!

Kent Bottles

The correct link for the physician report card blog http://ow.ly/3CaGX

Kent Bottles

The questions surrounding why accountability is so difficult for health care and for physicians were discussed in my two blog posts about physician report cards http://ow.ly/3CaGx and http://ow.ly/3CaMq. The call for transparent physician and hospital accountability elicited several comments from providers that questioned why the public needs to know and to hold us accountable. This same topic came up again in my blog post about how clinicians and the patients need to change http://ow.ly/3CaNW.


I’m glad you’re not letting this issue slide. Accountability is essential for growth and improvement, which we always need. Keep the conversation going.


“Dartmouth’s Elliott Fisher facetiously remarked that we cannot yet be sure whether accountable care organizations (ACOs) will actually be accountable, caring, and organized.”
The money quote.
Love it.


Accountability? To whom?!