More than 2.4 million beneficiaries are receiving care from providers participating in Medicare cost-savings initiatives. One of the more significant of those initiatives is the development of accountable care organizations (ACOs). An ACO is a group of healthcare providers—including primary care physicians, specialists, and hospitals—that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients.
“The goal of coordinated care,” according to the Centers for Medicare & Medicaid Services (CMS) ACO web page, “is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.”
ACOs are being driven by a push toward increased efficiency and payment based on standard and accepted outcomes, which are theoretically more easily achieved by a group of providers working together to deliver healthcare services. While ACOs will be rated and rewarded for performance, at present ACOs do not have enough standardized quality-of-care data to generate measures for comparison.
The market for ACOs is growing quickly. In December 2011, the U.S. Department of Health and Human Services (HHS) announced the first 32 pioneer ACOs. So far in 2012, HHS has announced the development of an additional 116 Medicare ACOs (27 in April and 89 in June), and it is estimated that there will be more than 300 Medicare ACOs by the end of 2012. Commercial health insurers are also revealing plans for ACO development.
An ACO requires at least one hospital be a part of the organization, so not surprisingly, physician and hospital organizations are the groups most focused on registering as ACOs. However, there is room for O&P in this structure as well.
What is required to apply to become an ACO?
- An ACO should have a strong primary care core at the heart of the organization and the capability to manage both the cost and quality of services.
- An ACO should possess sufficient size, infrastructure, and management acumen to prospectively plan budgets and necessary resources.
- An ACO should have a clear organizational mission and commitment to achieve quality and cost efficiencies.
- An ACO should make use of health information technology to manage patients across the continuum of care and across different institutional settings, including at least ambulatory and inpatient hospital care and possibly post-acute care.
Can an O&P practice join an ACO?
The preliminary information from CMS related to ACOs has not gone into great detail about how allied health and specialty health providers will be included in ACOs. However, there is little doubt that ACOs will inevitably grow to include allied health providers such as laboratory testing, therapy, and even O&P services. Since the rules are being formulated right now, it is critical that owners and managers of O&P clinical companies keep their eyes and ears open as the ACO world expands. Future articles in The O&P EDGE and EDGE Direct will strive to inform the industry about this important change to the U.S. healthcare landscape, but you can also keep track of the developments by regularly checking the CMS website.
For more information, CMS has put together a Medicare Shared Saving Program FAQ, which can be accessed at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP_FAQs.pdf