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Accountable care organizations (ACOs) aim to improve patient care by managing their conditions and maintaining access to affordable care.
To do so, ACOs amass data about patient health and spending, and there’s a potentially positive side effect: ACOs can serve as watchdogs to guard against wasteful and fraudulent spending in health care.
That has happened over the past few years as Medicare spending ballooned to pay for skin substitutes used to treat wounds on patients. The U.S. Department of Health and Human Services Office of Inspector General published a report with a title stating the problem: “Medicare Part B Payment Trends for Skin Substitutes Raise Major Concerns About Fraud, Waste, and Abuse.” Medicare spending for skin substitutes topped $10 billion in 2024 and is expected to reach $15 billion in 2025, prompting major changes for payment policy for 2026.
ACO leaders could see the spending patterns — and began growing alarmed, said Mara McDermott, J.D., CEO of Accountable for Health, a Washington, D.C.-based organization that advocates for accountable care. Accountable for Health has called the situation a crisis in Medicare, and not just because it involves massive amounts of money. The organization’s website includes anecdotes about patients suffering due to unneeded treatments that made their conditions worse, not better.