The recent Centers for Medicare & Medicaid Services (CMS) report on Pioneer Accountable Care Organization (ACO) performance demonstrated what is being widely and predictably described as “mixed” results. All 32 Pioneer ACOs achieved some quality metrics like improved cancer screenings and cholesterol reduction in diabetics, 13 qualified to receive some additional revenue from the Medicare shared savings pool and nine left the program. So in the first year of the Pioneer ACO program, 32 of our highest performing, most integrated health care delivery systems were able to form a crude bell curve, 13 improved, 10 about the same and nine dropping the program? Mixed results indeed. I wonder how effective such a program would be in the general market?

In juxtaposition, the CMS value based purchasing quality report released December 2012 contained a very unusual statistical aberration. Nine of the top 10 (including the #1 ranked hospital) and 48 of the top 100 hospitals, sorted by achievement of CMS value based purchasing metrics, were physician-owned.  So, the 238 physician-owned hospitals in the U.S. placed 48 of their members in the top 100 based on CMS value based purchasing metrics while the roughly 4,794 community hospitals in the U.S. placed 52 on the list?

It would seem to me that even a cursory examination of that finding would result in a best practices analysis of the reasons for such a phenomenon. Oh, I understand the arguments proffered by some that physician ownership is evil. My answer is quite simply… hogwash.

It’s time to remove the ban on physician ownership of hospitals, in particular general community hospitals. Let the local experts in health care truly align incentives with their hospital partners, not in some bizarre vertical employer/employee relationship, but in a shared fate, equity position.

Upon that framework, where quality is already king, where collaborative incentives are the rule, new payment models have a real chance of success and our nation’s health will improve.

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