Purdue University

After months of public and provider feedback, the Department of Health and Human Services released the final rules on accountable care organizations on October 20, 2011.

Accountable care organizations (ACOs) were included in the Affordable Care Act, and are designed to encourage primary care providers, specialists, hospitals, and other allied care providers to coordinate their care by joining together to be accountable for the quality and cost of their patients’ care. By coordinating care, it is hoped that ACOs will assist in the reduction of overuse — including too many or repeated tests, and contraindicated medicines — thereby producing both cost savings and improved patient outcomes.

The rules also establish the Medicare Shared Savings Program. Under this program, eligible providers who provide quality care (judged by meeting certain quality standards) and are also able to save money, may share in the savings. The quality measures include patient experience, care coordination and patient safety, preventive health, and at-risk populations. HHS stresses that the rules do not change Medicare or Medicaid eligibility, nor do they preclude a patient from visiting any Medicare-accepting provider.

To ACO or not to ACO?

Earlier this year, when preliminary ACO guidelines were announced, the reception was lukewarm. Nationally recognized providers, including the Mayo Clinic, Geisinger, and the Cleveland Clinic, indicated that they were reticent about participating in an ACO as it was defined at the time. The feedback led to some fairly significant revisions and simplifications in the final rule. EHR use is no longer a condition of participation, and quality measures were consolidated from 65 to 33.

ACOs may include insurance companies, groups of providers, and/or hospitals; however, solo practices will need to partner with other providers. Insurance giant Aetna has already established a version of an accountable care organization, which they call a collaborative care model.

Considering research opportunities

Given the early stage of ACO implementation, many research opportunities exist in a wide variety of fields, from management and engineering, to communication and psychology. Questions include:

• How will ACOs operate?
• What combinations of improved care and reduce costs will be required to make the model viable?
• What level of care will be necessary to reduce costs?
• How can care best be coordinated among a group of providers?
• How can providers best encourage patients to participate in their own care, thus being healthier and needing less care?

Sources:

HHS. ACO final rule. Accessed November 2, 2011.http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf

www.healthcare.gov. ACO fact sheet. Accessed November 2, 2011. (http://www.healthcare.gov/news/factsheets/2011/10/accountable-care10202011a.html).

AAFP. Payment Expert Says Primary Care Physicians Should Drive ACOs. Accessed November 2, 2011. http://www.aafp.org/online/en/home/publications/news/news-now/practice-professional-issues/20111005millerqa.html

Becker’s Hospital Review. Mayo, Geisinger, Cleveland Clinic May Not Participate in ACOs. Accessed November 2, 2011. http://www.beckershospitalreview.com/hospital-physician-relationships/mayo-geisinger-cleveland-clinic-may-not-participate-in-acos.html

CMS. Proposed Rule versus Final Rule for Accountable Care Organizations (ACOs) In the Medicare Shared Savings Program. Accessed November 2, 2011. http://www.cms.gov/aco/downloads/Appendix-ACO-Table.pdf