On March 31, 2011, Health and Human Services published the notice of public rule making (NPRM) for Accountable Care Organizations (ACOs). Established by the Affordable Care Act, ACOs are proposed to be a potential solution to the burgeoning expense and fragmented delivery of health care within this country. CMS has made a commitment in recent years to move from a passive payer to an active purchaser of quality care. Phrases like “value-based purchasing” capture this sentiment by conceptually defining the following relationship:
Value = Quality / Cost
Those of you who have followed this discussion in recent years know how difficult it is to translate this concept into the reality you face in practice every day.
So what exactly is an ACO? Fundamentally, an ACO is a collection of health care providers organized around the principal of delivering coordinated care to a group of Medicare beneficiaries. Importantly, the Medicare beneficiary may continue to pursue care within the Medicare fee-for-service environment while participating in the ACO. (The patient is not locked in as they were in the early HMO/gate keeper model.) If the ACO successfully creates value by increasing quality and reducing costs, the organization will receive a share of the Medicare savings achieved. Under the proposed rule, the ACO itself will have the opportunity to take varying degrees of risk; and, as one might expect, those willing to take greater risk will have the opportunity to realize a greater return.
Implementing Health IT Is a Given
John Halamka has provided an excellent overview of the ACO NPRM from the Health IT perspective. It is very clear that participants in an ACO will be expected to meet the requirements for meaningful use and the CMS e-prescribing program concurrently. In fact, demonstrating meaningful use in the eyes of CMS has been established as a rate-limiting step in the creation of an ACO (at least 50% of the primary care providers within the ACO must be meaningful users).
Health information technology will be a cornerstone of all successful ACOs. Both sides of the value equation above (quality improvement and cost reduction, or at least slower growth in costs) will require the utilization of a robust health IT infrastructure that creates interoperability between disparate systems and facilitates the delivery of the right information at the right time to the providers (and their patients) within the ACO.
ACOs and the Nephrologist
What does this mean for the typical nephrologist? The answer remains to be seen. Today, primary care providers are at the center of the national ACO conversation. In spite of the confusion surrounding this topic, the hospitals in your communities are likely jockeying for a seat at the table. Sides perhaps are being chosen in competitive markets, and nephrology practices in these environments may begin to feel some pressure. The public comment period for the NPRM will last for 60 days and we should see the final rule sometime this summer. In the meantime, let us know what you think about ACOs by adding your comments here.