Know Your Community: Accountable Care Organizations

My colleagues Dr. Chuck Haine and Alistair Jackson have written previously about Accountable Care Organizations. (See the Archives for Chuck's post from December 23, 2011 and Alistair's from February 17, 2012.) My question for you is, have you taken the time to see if there is an ACO in your area?  ACO’s represent a new patient referral and reimbursement system whereby the ACO receives a bundled payment for the care of the patient instead of each provider being able to bill fee-for-service to Medicare. The ACO then becomes responsible to distribute payments to the providers involved in the care of the patient. This in turn means two things: one, that the ACO chooses the participating providers and, two, that the ACO controls access to patients.

My point today is this: if you don’t learn how to become part of this new delivery system, it will affect your access to patients.  You owe it to yourself at least to be finding out if you have an ACO in your locality, or if any of the health systems in your area are working toward forming one.  


There are many ACO's functioning now already. Another group will begin getting bundled payments from Medicare on July 1, 2012, then another on Jan 1, 2013.  Since many ACO's are still at the formative stage, it's the perfect time for you to get involved.  Once they're functioning, it may be too late to open the door for your participation.


ACO's are a good example of how health care reform doesn't apply only to providers who take Medicare. You may not be concerned about stimulus incentives since, based on your current Medicare volume, your eligibility is low. Correspondingly, you may be even less concerned about  a small Medicare penalty. But what if, by virtue of the fact that you do not have certified EHRs and cannot communicate as required with other health care providers, you do not qualify to participate on a chronic care team? Losing access to patients is certainly a more serious matter than a 2% Medicare penalty. This is why we have maintained that the EHR Incentives program is really not about the money - it's about the survival of your business. Know your community and get involved in its healthcare programs. They're going to affect your business for better or for worse. It's within your grasp to make it for the better.


Jim Grue, O.D.