Understanding the Latest Industry-wide Sea Change

Accountable Care Organizations (ACOs) are dominating the conversation on managed care right now for good reason: they are the latest presumptive saviors of the United States’ healthcare system. On the surface, the ACO seems like a bit of a fantasy, as it is purported to replace the current fee-for-service model with a program that is not only more cost effective to providers and patients, but more efficient to boot. That is a tall order, but the reasoning behind the move toward ACOs is sound, and could be beneficial for specialists.

ACOs were borne out of the Patient Protection and Affordable Care Act of 2010, which called for a new program that would foster increased accountability for the patient population, coordinate services under Medicare Parts A and B and encourage the development of superior care processes. ACOs will include metrics to show patients that their care is actually getting better, plus a payment system that rewards providers that can reduce costs while still improving the quality of the care provided.

Here’s where the “accountability” comes in: in order to receive these rewards, ACOs must meet five standards for quality in the areas of patient/caregiver care experience, care coordination, patient safety, preventative health and at-risk/frail elderly health.

Specialists can expect ACOs to have a gradual impact on their day-to-day operations. On the plus side, the shift away from the fee-for-service system will mean you’ll be able to spend less time trying to manage large numbers of patients in order to generate income, and more time envisioning ways to add value to your patients’ care experience—not just in the clinic, but throughout the ACO. Also, depending on your discipline of care, you will be able to provide important insight that may steer clinical decisions for a patient after he or she has left your practice.

On the down side, you will have to watch for changing payment methods over time, such as reductions for repeated tests or procedures, which may negatively affect your billing. You may wish to negotiate exclusions into your contract for areas where reductions or other changes could expose your practice to greater risk. In addition, you can expect an increase in your paperwork as you will be required to demonstrate compliance with government regulations.

Embracing this industry-wide sea change can have a positive outcome for you and your practice, but it may not be for everyone, and ultimately you will need to make the appropriate inquiries, do your research and take things slowly as you proceed.