Acronyms of Change, Part 3 (ACO)

We've heard enough about ACOs that most of us probably know the acronym means Account Care Organization. Accountability is another theme we're familiar with since it's the first A in HIPAA. Portability and accountability are major themes in health care reform.


While eligible professionals and hospitals are incentivized by stimulus grants, ACOs are driven by the Shared Savings program. You'll find that the "large health systems" I've referred to in parts 1 and 2 of this series are also the kinds of organizations that will rally under the banner of an Accountable Care Organization.


In his December 20, 2011 post (see Archives), my colleague Dr. Jim Grue wrote, "There are a number of team delivery models functioning but the ACO model based on the Medical Home structure is rapidly dominating the market. For ECPs not to lose ground on key survive and thrive issues, it is important to understand what preparatory steps are needed right now." While you're reading that, also read the Dec.23, 2011 post by our third "musketeer" Dr. Chuck Haine who wrote about the Pioneer ACO. We'll cover the Medical Home model in more detail at a later date. For now, let's understand the shared savings motivator.



The Affordable Care Act (ACA) required CMS to establish a Medicare Shared Savings program by Jan. 1, 2012 "that promotes accountability for a patient population, coordinates items and services under Medicare Parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery”. Participating entities, i.e. ACOs, that meet quality and performance standards are eligible to receive payments for shared savings. 

An ACO refers to a group of physicians, hospitals and other suppliers of services that will work together to provide coordinated care to Medicare beneficiaries. The statute lists several groups of providers of services and suppliers that are eligible to participate as an ACO:

• ACO professionals in group practice arrangements.
  
• Networks of individual practices of ACO professionals.
  
• Partnerships or joint venture arrangements between hospitals and ACO professionals.
  
• Hospitals employing ACO professionals.
  
• Such other groups of providers of services and suppliers as the Secretary determines appropriate. 
  

Today's takeaway is that ACOs matter. Granted, they appear to be all about larger health systems, hospitals and group practices. But we must be clear that, as the health care reform game plays out, ACOs will take control of access to patients, in the name of "savings", shared savings. Those patients need eye car too and if you're not involved in a local ACO, those patients will be awarded to others who are. Remember that even though hospital-based EHRs don't do as good a job of eye care as your EHRs do, they are nevertheless certified and meet Meaningful Use criteria. That means you can - and will - lose patients to those providers and systems. Be alert to that and prepare for this certain future.


Though not oriented to your eye care interests, Medscape Today offers an informative series on ACOs and Shared Savings. Find it here.


Alistair Jackson, M.Ed.