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Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA |
ACO’s: The Future? Good or Bad?
ACO. Accountable Care Organization. Those words make me worried. ACOs became a highly public point of discussion when the Patient Protection and Affordable Care Act became law. Oddly only a few pages were spent in the voluminous document discussing ACOs. Yet they’ve certainly generated a significant amount of discussion. For all the discussion, do we really understand what these entities are and what effect they might have on our lives as healthcare practitioners?
I’ve always found that when one person has a question, it’s usually a sign that others have the same question. While contemplating ACOs, I realized I don’t have a strong understanding of this topic, so most likely others in our community are unsure as well. As such I’d like to devote this week’s issue to the topic of ACOs. What are they and what effect will they have on us in the future? I’ll disclaim at the outset that I am not an expert on healthcare policy, but rather another doctor who’s trying to understand the forces at work. I would invite anyone with a particular interest or knowledge in this subject to comment on the eTalk website.
What is an ACO?
An ACO is a group of doctors and hospitals that agree to provide care to patients. This is an alternate healthcare delivery method that essentially combines the work of separate medical services in one organization. For example, currently, if a primary care doctor wants to refer a patient to me, a specialist, he may do so, assuming I’m on the patient’s health insurance panel. I then may refer that patient to another specialist, perhaps a physical therapist after a surgical procedure. In an ACO, that patient would stay within the ACO to receive all their services, rather than going to various individual providers. This part sounds to me like health maintenance organizations (HMO).
The other part of the ACO proposal of healthcare reform is that reimbursement will be based on outcomes, namely quality care measures and evidence of cost reduction. As the current system seems to be heading, outcome measures would be tracked and a “successful” ACO paid accordingly.
What are the rules (so far)?
The Senate Finance Committee proposed seven criteria for ACOs to follow:
- A 2-year participation contract
- A formal legal structure
- Inclusion of primary care physicians with at least 5,000 patients
- A list of primary care physicians and subspecialty physicians who are providers to the Centers for Medicare & Medicaid Services (CMS)
- Contracts with care groups of specialty physicians outside the ACO
- Management and leadership structure for joint decision making.
- Defined processes for promoting evidence-based medicine and reporting on quality, cost reduction measures, and coordinated care.
These seven criteria originate from the Senate Finance Committee’s document called Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs.
Follow this link to view a copy of the document.
Good or Bad?
The Senate Finance Committee proposed seven criteria for ACOs to follow:
I’m going to hold my judgment on ACOs for the short term. However, since I’m a born skeptic, I’m full of questions.
- What will the medical profession look like with ACOs?
- Will ACOs force physicians and other healthcare providers to become employees of larger organizations?
- How will physicians who want to remain sole proprietors participate in this system?
- Is this the corporatization of medicine?
- Will the quality of patient care actually improve?
- What will these quality measures actually look like?
- Will we be so concerned about cost that we eliminate care?
The creation of ACOs seems to me a natural extension of the current “outcomes measures” movement coming out of the Centers for Medicare and Medicaid Services (CMS). Whether it’s core measures (CHF, SCIP, MI, etc.) or the upcoming penalty decrease in reimbursement by CMS for physicians not using electronic health records (meaningful use) it seems control of cost is here. What our medical profession looks like as a result of these changes is anyone’s guess. Either way, get ready for a ride.
Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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