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Fair and Equitable: Considerations for the Ethical Distribution of Shared Savings in ACOs

Released: 12-Mar-2014 3:00 PM EDT
Source Newsroom: Johns Hopkins Berman Institute of Bioethics
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Citations JAMA. 2014;311

WHAT: Viewpoint in the Journal of the American Medical Association (JAMA) suggesting five ethical considerations for Accountable Care Organizations (ACOs) to use in determining fair distribution of the “shared savings” ACOs receive if they meet quality targets while reducing cost of care (more on ACOs in primer below). This opinion is one of the first examinations of the federal requirement that the distributions be “fair and equitable.”

WHEN: March 12, 2014



Matthew DeCamp, MD, PhD, Assistant Professor, Berman Institute of Bioethics and Division of General Internal Medicine, Johns Hopkins University

Jeremy Sugarman, MD, MPH, MA, Harvey M. Meyerhoff Professor of Bioethics and Medicine, Johns Hopkins Berman Institute of Bioethics and Division of General Internal Medicine, Johns Hopkins University

Scott Berkowitz, MD, MBA, Assistant Professor, Division of Cardiology and Medical Director, Accountable Care, Office of Johns Hopkins Physicians, Johns Hopkins Medicine

WHY: Ensuring that distributions of shared savings are fair is important as an ethical matter and may also be critical to ACOs’ long-term success. Fair distributions could contribute to greater support of the ACO concept and achieving ACO goals.

RELATED CONTENT: Blog post on the issues by author Matthew DeCamp, at the Johns Hopkins Berman Institute of Bioethics’ Bioethics Bulletin:

PRIMER: In ACOs, individual clinicians (including physicians, physician assistants, and nurse practitioners, among others), group practices, and in some cases hospitals, contract with payers to be jointly accountable for the health outcomes and expenditures of a defined patient population. By meeting specified quality measures while keeping expenditures below defined benchmarks, ACOs share in the monetary savings generated.
ACOs have significant flexibility in deciding how to use and distribute shared savings because federal regulations only require that they support the overall ACO mission and be “fair and equitable.”

Since 2012, Medicare ACOs have proliferated to cover more than five million Medicare beneficiaries in more than 360 organizations nationwide, according to the Centers for Medicare and Medicaid Services.

CONTACT: Leah Ramsay,, 202.642.9640

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