What GIs Need to Know about Accountable Care Organizations
Beginning in 2012, physicians will be encouraged to join accountable care organizations (ACOs) through which they would be eligible for enhanced payment incentives for Medicare patients based on quality and efficiency improvement.
It is essential that GIs keep track of this issue since ACOs have the potential to shape the future health-care system.
AGA experts reviewed the final ACO rule released by CMS and offer important insights about the implications for specialists. We are pleased that CMS considered our comments to the proposed rule and included many of our recommendations in the final rule. Compare CMS’ changes to the ACO rule in response to AGA’s comments.
ACO Basics
Under the Medicare Shared Savings Program (MSSP), ACOs are required to have primary care physicians caring for at least 5,000 Medicare beneficiaries and have the ability to report data on cost, quality and overall patient care experience. Participating groups must agree to enroll for at least three years and demonstrate the legal structure that permits them to receive payments for shared saving from CMS and distribute a portion of those payments to the groups of providers. The shared savings would be generated when the group provides care to beneficiaries for less than a Medicare benchmark cost, while also meeting criteria for patient service and quality of care.
The goal of ACOs is to provide coordinated and more efficient patient care than is currently being provided. Members of an ACO work together on shared savings, which distinguishes it from health maintenance organizations, or HMOs.
Who Comprises an ACO?
The focus of the MSSP is on the role of primary care physicians in providing care to Medicare beneficiaries. However, specialists can participate in the MSSP as either an owner, an ACO CEO, an ACO participant, a member of the ACO governing body, a senior level medical director, or part of the physician-directed quality assurance and improvement program. Read more about the role of specialists under an ACO.
Outside of the MSSP, in the private sector, a common misconception is that ACOs need to include hospitals. But they don’t. ACOs are not provider networks, therefore, group practices can perform as an ACO. Every region is different and will have different needs for clinical integration, either horizontal or vertical.
What does all of this mean for you and your practice? Which ACO structure will work best for you? Will an ACO work for you in your region?
Resources
AGA Resources
- How Will ACO Final Rule Impact Your Practice?
- Role of Specialists in the MSSP Establishing ACOs
- Review of CMS Changes to the ACO Rule in Light of the AGA’s Comments
- ACO Rule Revised to Increase Provider Participation
- Gastroenterology in a New Era of Accountability: Part 3. Accountable Care Organizations
- AGA Responds to ACO Proposed Rule
- The Top 10 Things GIs Should Know Now About ACOs
- AGA Assumes Task of Deconstructing ACO Proposed Rule and What It Means for GI
- What GIs Need to Know About Accountable Care Organizations
- The Affordable Care Act: How It Will Affect Your Relationship with Your Colleagues
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Podcast
Listen to a podcast discussion between two GI thought leaders who are involved in ACOs in their areas. Featuring: Lawrence R. Kosinski, MD, MBA, AGAF, FACG, managing partner, Illinois Gastroenterology Group, and John Garrett, MD, past president and current Board Member, Asheville Gastroenterology Associates, about ACOs and what you need to know to help manage and position your practices wisely.
Listen now
Recommended Reading
The following resources have been reviewed and are recommended by AGA experts.
Government Resources
- CMS Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, Federal Register, Nov. 2, 2011
- Summary of Final Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program, Medicare Learning Network, October 2011
- Advance Payment Accountable Care Organization Model, CMS Innovation Center, October 2011
- Accountable Care Organizations: What Providers Need to Know, Medicare Learning Network, October 2011
- Improving Quality of Care for Medicare Patients: Accountable Care Organizations, Medicare Learning Network, October 2011
- Medicare Shared Savings Program and Rural Providers, Medicare Learning Network, October 2011
- Methodology for Determining Shared Savings and Losses under the Medicare Shared Savings Program, Medicare Learning Network, October 2011
- Accountable Care Organizations and the Medicare Shared Savings Program, Congressional Research Service, Nov. 4, 2010
Other Resources
- Accountable Care Organizations in Medicare and the Private Sector: A Status Update, Robert Wood Johnson Foundation, November 2011
- FAQ On ACOs: Accountable Care Organizations, Explained, Kaiser Health News, Oct. 21, 2011
- Accountable Care Organization for PPO Patients, Integrated Healthcare Association, 2011
- ACOs, CO-OPs and other Options: A "How-To" Manual for Physicians Navigating a Post-Health Reform World, American Medical Association, 2011
- Case Study of a Primary Care–Based Accountable Care System Approach to Medical Home Transformation, Journal of Ambulatory Care Management, January/March 2011
- ACOs Can Work with Physicians in Charge, American Medical News, Jan. 31, 2011
- Creating Accountable Care Organizations (Video), New England Journal of Medicine, Oct. 7, 2010
- Becoming Accountable — Opportunities and Obstacles for ACOs, New England Journal of Medicine, Oct. 7, 2010
- Health Policy Brief – Accountable Care Organizations, Health Affairs and the Robert Wood Johnson Foundation, August 2010
- Building Accountable Care Organizations That Improve Quality and Lower Costs—A View from the Field, Commonwealth Fund, June/July 2010
- Implementing Accountable Care Organizations, Berkeley Center on Health, Economic and Family Security, May 2010
- Reforming Provider Payment: Moving Toward Accountability for Quality and Value (video and issue brief), Engelberg Center for Health Care Reform at Brookings, March 11, 2010
- Accountable Care Networks: Transitions for Small Practices and Community Hospitals, Pittsburgh Regional Health Initiative/Jewish Healthcare Foundation, 2009
- How to Create Accountable Care Organizations, Center for Healthcare Quality and Payment Reform, Sept. 7, 2009
Updated Nov. 4, 2011
