DMBN: You spoke last year at AHRA about the rise of ACOs. You said you were seeing more and more cropping up on a daily basis. Now that a year has passed, can you give us an update on ACOs?

LS: They took off a lot faster than people expected. Many were on the fence thinking we'd only see a few. But since that time we've seen a lot of growth. Between Medicare and private payer ACOs we are close to 500 right now. And I think we'll see that number increase.

ACOS are still evolving. There is no cookie-cutter approach either, especially because populations are different. I think we'll see a lot of stops and starts and changes in delivery models as people figure out what works and what doesn't.

Bundled payment models are also increasing and some of the providers are working under both the bundled and ACO models. Bundled payments are a little different in that you're paid a fixed amount for an episode of care-as opposed to looking at shared savings at the end of the year. Although in both you're focusing on population health management.

DMN: The news about the Pioneer ACO program not managing to lower costs is causing quite a stir. Do you have any thoughts on this?

LS: Obviously, it's a new payment model so it's going to take time to work out the kinks. I think some of issue is that not all those pioneer ACOs failed. In fact, a good portion achieved cost savings, but there were some that didn't. So you have to be careful about not drawing too many conclusions from a one year study like that. And you have to remember that some did achieve their cost savings. So if I were Medicare or other providers, I would look at them and see what they did right and what we can replicate from them.

The Pioneer ACOs that have announced they are dropping out of the program have said they are moving to the Medicare Shared Savings program which is just the other ACO model - there are three: Pioneer, Medicare Shared Savings program, and Advanced Payment ACOs.

DMN: What else do you think our audience should know about reimbursements?

LS: I think it boils down to moving from volume to value with a bigger emphasis on appropriateness and evidence-based medicine, and also breaking down the care cycle in particular as patients move from hospital to home but also within the hospital. As long as we're faced with this budget crisis, reimbursement will always be on the table, especially for technology like imaging, which is perceived as costly. So it's important for radiology to take the lead in promoting appropriate utilization and it's critical that we keep at it.

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