Accountable Care Organizations aim to rein in health care costs while improving patient health. But the medical device industry warns that a "cheapest is best" model for ACOs could stifle innovation unless provisions are in place to support early adopters of new technology and emphasize outcomes over cost savings.

In a blog Monday on the health policy journal Health Affairs, Stephen Ubl, president of the the device lobby Advanced Medical Technology Association, said if not handled correctly Medicare's forthcoming ACO model could be a "roadblock" to new device development because it could "discourage physicians from adopting new forms of care."

"Depending on how the new program is implemented, ACOs could instead have unanticipated negative effects: a chilling of medical innovation and progress and a 'cheapest is best' style of medicine that leaves some patients behind," Ubl wrote.

Ubl's concerns echo warnings the medical device industry sounded in December, when AdvaMed asked the Centers for Medicare and Medicaid Services to make sure doctors weren't penalized for adopting new technology when the agency was crafting rules for its ACO program, which starts on a voluntary basis next year.

ACOs -- quite simply -- are a model where doctors work together to improve quality and drive down costs of care by, for example, keeping chronically sick patients healthy and out of the emergency room. As an incentive, the doctors are able to pocket some of the savings they realize for their payers, provided they also meet quality-control metrics.

But Ubl suggests draft rules released last month by CMS for its ACO program haven't addressed the industry's concerns. For one, Ubl argues that meeting quality measures required by ACO-participating doctors to ensure they don't stint on care might be necessary for providing quality care, it's not sufficient, as the measures tend not to focus on outcomes and leave out "vast areas of clinical practice."

"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," he said.

The solution, Ubl says, could be tweaking the rewards to apply mainly to individual physicians' quality scores, and also to provide oversight from an independent group -- and not CMS monitors, as proposed under the draft rules -- to ensure doctors don't withhold care for financial reasons.

Perhaps more significantly, the group also wants ACO quality measures to be flexible enough to allow doctors to try new treatments without getting penalized, and also to allow measures to capture data over the long-term to reflect benefits that might not be seen immediately.

"For example, a replacement heart valve may be more expensive initially but it may last 25 years instead of 10 years," Ubl said.

But not everyone agrees. In a comment to the article, a doctor and head of health care operations for the D.C. Primary Care Association said we should "stop looking for technology based solutions to our [health problems.]"

"We don't need a cabinet full of new devices, an army of new drugs or new imaging technology," the poster, M. Williams, wrote. "We need to focus our efforts on not getting sick. If we as a country stop smoking, eat between 2,000 and 3,000 calories a day and walk half an hour every other day, our health care costs plummet."

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