ACOs and the Bureaucratization of Care

In an interesting post at the Health Affairs blog Abdulrahman El-Sayed looks at the similarities of the No Child Left Behind attempt at education reform and CMS regulations concerning ACO scoring. While El-Sayed’s concern is with potential equity issues being exacerbated by the ACO rules, I’d like to focus on process effects.

The No Child Left Behind effort was criticized as incentivizing schools to teach to a standardized test. And, finally, fraud crept into the system as some schools were caught ‘adjusting’ test results.

Will something like that happen with ACOs. Given the amount of money involved – yes!

You can hear the consultant’s pitch now, “using our proven system, we can maximize your reimbursement” etc. While the reformer will argue that it is just a matter of designing the right measures, we all have seen how government programs work. Inevitably, protocols will be adjusted to maximize the score regardless of the underlying health status of the patient. That’s how bureaucracy works.