The government recently released its final revision to the proposed rules governing accountable care organizations (ACOs) http://www.cms.gov/aco/downloads/Appendix-ACO-Table.pdf. These organizations will herald the beginning of outcomes based reimbursement which will replace volume-based payment systems. Three sub-agencies will be coordinating Medicare and Medicaid payment policies. The IPAB (Independent Payment Advisory Board) will concentrate on Medicare. It has already been criticized as having too much power for a small board. The Center for Medicare and Medicaid Innovation will be testing new payment and delivery systems, and the PCORI (Patient Centered Outcome Research Institute) is charged with evaluating comparative effective research.

What are your thoughts on facilities such as Level I Trauma Centers who have a higher level of acuity face lower reimbursements when the patients arrived in an almost reversible condition?