“Patient centeredness,” “fragmentation” and “value based purchasing” are just a few of the terms that are peppered throughout the newly proposed regulations for accountable care organizations (“ACOs”). The healthcare reform law established the Medicare Shared Savings Program for ACOs as a key way to accomplish its two core objectives: (1) reduce healthcare costs, while (2) preserving and improving quality. Like most new legislative ideas, the ACO regs raise lots of questions.
Who can become an ACO?
Answer: Pretty much any legal entity that complies with state law, has a tax ID number, applies successfully and which:
- Agrees to participate for three years;
- Cares for 5,000 Medicare patients;
- Is prepared to receive and distribute shared savings;
4. Is prepared to repay shared losses (if it takes economic risk);
5. Establishes reporting, and ensures ACO participant and ACO provider/supplier compliance with program requirements, including the quality performance standards;
6. Has shared governance that provides all ACO participants proportionate control over the ACO’s decision making process and includes Medicare patient representatives;
7. Is operated and directed by Medicare-enrolled entities that directly provide health care services to Medicare patients. ACO participants (e.g. physicians, hospitals) must have at least 75 percent control of the ACO’s governing body;
8. Has sufficient primary care physicians to meet the primary care needs of the ACO patients;
9. Has administrative and clinical organization and leadership;
10. Is patient-centered though the use of such things as patient assessments and individualized care plans; and
11. Is subject to substantial monitoring and reporting requirements, including public reporting of quality data to ensure transparency.
