There has been much discussion in the US lately surrounding accountable care organizations (ACOs), a piece of the Affordable Care Act anticipated to be implemented sometime in 2012. In simple terms, these organizations are networks that are designed to bring multiple levels of health care together, including physicians, clinics, and hospitals, with the idea being that they all share responsibility for providing care to patients under the Medicare system. These organizations offer a lot of benefits in theory They are designed to improve the overall quality of health care in the US while lowering health care costs. How is this possible, Well, the argument is that the current system provides incentives for physicians to overproduce (such as by conducting more tests than are medically necessary) or to pick treatments based on reimbursement levels (and thus profitability), rather than what might be in the best interest of the patient.

Of course, medical device manufacturers are concerned it's possible that the ACOs could cause physicians to opt for lower-cost treatment alternatives, such as drugs or lower-cost devices, in order to earn the financial incentives that will be provided for meeting the goals of the program. Taking that point a little further, it might become difficult for patients in the US to access innovative but costly new therapies available because physicians and hospitals may not have the incentives to offer them. Let's not forget (how can we, really) the fact that manufacturers are already upset over the so-called innovation crisis in the US this will definitely add some ammunition to that argument, for better or for worse.

Device manufacturers have not been sitting idly by they put forward some recommendations to the Centers for Medicare & Medicaid Services (CMS) that might have made ACOs more palatable for them. AdvaMed, the medical device manufacturer lobby group, was not, however, happy with the final rule by the CMS, which was released in October 2011. In fact, this final ruling reduced the number of quality measures from 65 to 33, further boosting fears that doctors and hospitals will not have adequate motivation to pick high-quality, but more expensive, devices. The CMS did, however, state that more quality measures could be added in the future so we probably haven't seen the end of this fight yet.

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