ACOs, your new referral center

Accountable Care Organizations (ACOs), in the opinion of most national authorities, are the direction healthcare care delivery and reimbursement is going. It's important therefore that you understand the effect of this trend on your practice. There are two important points:

1.  Reimbursement. The way you will get paid for patients covered through an ACO will change. The ACO will receive a “bundled” payment for the care of the patient and the ACO will pay the providers delivering the care. You will no longer be able to bill the insurance company under a fee-for-service payment system.
2. Access. Your access to patients covered by the ACO will be affected.  A fundamental concept of the emerging health care delivery system is that outcomes for patients with chronic conditions is best delivered through teams of providers communicating closely about the patient, with the patient an integral part of the process, in order to determine the best management plan. Coordinating this team delivery of care is one of the main functions of the ACO. If you are not part of the team delivery system, you will likely lose access to these patients. As a part of the coordination of care, the ACO not the patient actually schedules the patient's routine appointments with team members.

The ACO also is responsible for ensuring that every provider who sees the patient has the appropriate patient medical information. (This is information shared among all team members.) The ACO, as part of its reimbursement, gets a specific fee for doing this coordination. This is why the ACO is becoming your new referral center.

There are three things you need to be doing before you'll be considered by an ACO to be part of a care team:

1. You must be using a certified EHR;
2. Your EHR must have the proper capabilities to communicate electronically with the ACO;
3. Most likely, you will need to demonstrate a changing culture in your practice, that you are embracing the implications of being an effective team member versus a standalone practitioner, as is now the dominant model.

Changing your practice to demonstrate the ability to be a productive team member is significant. Fortunately, there are now groups of eye care professionals collaborating to go through this process. We'll be sharing insights, on an ongoing basis, right here on EMRlogic Live. This is new territory for all. We hope you'll check back often and keep learning with us.

Jim Grue, O.D.