Wolterman says that even though the risk is capped in the two-sided model, healthcare providers are still on the hook for significant costs. "And the ability to collect that money from private physicians -- and they are proposing to do that with a 25% withhold off their current fee for service -- that is a pretty hard sell to doctors," he says. "Hopefully, they will come out with some more well thought out final regulations this summer. Right now there is a lot of pause out there. We may be willing to take the risk and use it as a three-year teaching demonstration project for our doctors and our system, or we may not if our doctors aren't happy with the terms."
If the federal government wants to grow the ACO model, Wolterman says it will have to return the concept to a shared savings program for all three years and reconfigure other financial incentives and risks. "Those who are far enough along and want to go at risk for three years, fine, let them. I have no problem with that. But allow the rest of America to use this as an opportunity to begin the change of working with their doctors. That is what this was supposed to be," he says.