Setting up a practical accountable care organization

June 25, 2011

The Patient Protection and Affordable Care Act gives new impetus to form accountable care organizations to better coordinate the care of their patients, especially those with chronic diseases, and to ensure a continuum of care.

Before we get into those details, some background is needed. An ACO, which may affiliate with a hospital, consists of a group of doctors working together under one legal umbrella. ACOs create incentives for healthcare providers to treat an individual patient across care settings–including doctors' offices, hospitals, and long-term care facilities. Various models exist. Some ACOs consist only of primary care doctors, whereas others include specialists. When ACOs own the practices, its doctors are employees. Well-designed
integrated delivery networks such as the Mayo Clinic, Geisinger Clinic, Cleveland Clinic, and Marshfield Clinic could be reorganized to comply with the new Centers for Medicare and Medicaid Services' (CMS') definition of an ACO under the PPACA.

The PPACA specifies that an ACO may include the following types of groups of providers and suppliers of Medicare-covered services:

Organized medicine is active in determining how ACOs will affect physicians' practices.

"The [American Medical Association (AMA)] made recommendations to CMS on how to make it possible for physicians in all practice sizes and settings to successfully lead and participate in ACOs, including flexible requirements for ACO structure, transitional steps for ACO formation, increased access to loans and grants for small practices, easing of antitrust restrictions, and timely access to quality data. The AMA looks forward to working with the [Obama] Administration to develop physician-led new models of patient care," says Jeremy A. Lazurus, MD, speaker, of the AMA House of Delegates.

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