Accountable care organizations (ACOs) have taken a prominent position in the healthcare reform movement as part of cost-saving strategies. But in the 2011 National Physicians Survey conducted by HCPlexus and Thomson Reuters, a full 45% of the nearly 3,000 participating physicians said they did not know what an ACO was.1
“The other half of physicians who have read the ACO regulations are blown away when they read them,” says Rodney Hochman, MD, a rheumatologist and executive vice president of the Swedish Medical Center in Seattle.
So, what exactly is an ACO? “The broadest definition of an ACO is any organization that is clinically and fiscally responsible for the entire continuum of care for their patients. The key words in this definition are ‘fiscally’ and ‘entire continuum,’ ” says Joseph Golbus, MD, president of the NorthShore University HealthSystem Medical Group and clinical associate professor at the University of Chicago Pritzker School of Medicine.
“We rheumatologists have always been responsible for the care of our patients,” Dr. Golbus says. “But now, with ACOs, the financial risk is being transferred from health plans and payers to providers. That changes things. In an ACO, we are fiscally responsible for entire continuum of care for our patients. Not just inpatient or outpatient care, but also extended care, hospice, the whole deal,” he adds.
In the ACO model, the primary-care physician is the gatekeeper. A real fear among rheumatologists and other cognitive specialists, who primarily provide evaluation and management services, is that they’ll be left on the side of the road, as Dr. Hochman puts it. “Now is the time to make sure they’re playing a significant role,” he stresses, because ACOs are on the verge of becoming mainstream.
Medicare and Medicaid ACOs
The broad goals of ACOs are to encourage care integration, improve care quality, and realize cost savings. According to an often-quoted statistic, the average American on Medicare is cared for by two physicians and five specialists, more if the person has a complex chronic disease. Coordination of care is an obvious problem.
“This is a fundamental change in the delivery and reimbursement model that moves to population healthcare,” says Warren Skea, PhD, director of PwC’s Enterprise Growth Practice, who was a keynote speaker at an ACR Leadership Development Conference earlier this year. “You’re managing patients not on a fee-for-service or transactional basis, but managing all the healthcare costs for an entire population of patients. ACO participants are responsible for overall quality, as well as financial consumption. Assuming there are quality outcomes and savings, there is an ability to share in those savings,” says Dr. Skea.
