So, where have I been? Anyone who has written a successful blog will tell you that you need to publish often to attract readers. It’s been months since my last post. I apologize for the delay, but I’ve been busy working as the Medical Director for an Accountable Care Organization (ACO) since August and think some of my experiences can offer some insights about new developments in our health care system – insights that everyone can use. In this post, I’ll give you a brief overview of Accountable Care Organizations.
What is an ACO? CMS through regulations found in the Patient Protection and Accountable Care Act is encouraging the formation of ACOs to address some of the problems in our health care delivery system through innovation that moves us from a fee for service to fee for value. Here’s the definition from the Centers for Medicare & Medicaid Services (CMS):
“ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.”
Through an application process, ACOs are designated by CMS. They are focused on achieving the Three-Part Aim of:
- Improving the experience of care
- Improving the health of populations
- Reducing per capita costs of healthcare
To make sure that quality is enhanced, ACOs must report 33 quality measures within the following 4 areas:
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Care coordination & patient safety
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Preventive health services
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Care for at-risk populations
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Patient & caregiver experience of care
In my next post I’ll talk about some of the opportunities for ACOs to improve how care is delivered for Medicare patients, many of which are applicable to the entire U.S. population.
For Your Health – Dr. Bob
Implied in savings generated by the ACO is less revenue for the participants. How is sharing in the savings beneficial to doctors, etc if in the final analysis they are merely getting back a portion of what they had before becoming “more efficient?” where is the long term incentive for providers to do this?
Good thoughtful questions! The ACO is responsible for all the costs that the Medicare beneficiaries that are attributed to it may incur, not just the costs incurred by the services its participants provide. That would include the costs of hospitalizations, x-rays, lab testing and physicians’ fees both primary care & specialist. So, an ACO composed of primary care physicians can benefit if, by better care management and coordination, they decrease unnecessary hospital admissions. Depending on their quality score, they will share a portion of the savings with Medicare. Even the hospitals can benefit from the decrease in readmissions since Medicare has started to financially penalize hospitals when their readmission rates for some diagnoses are too high.
In the next day or two I’ll explain this in more detail in my next post.