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Understanding Accountable Care Organizations

DrCBy John D. Cacciamani, Jr., MD, MBA

I find that my physician colleagues, many of whom are busy with everyday caring for their patients, need some explanation when it comes to understanding Accountable Care Organizations [ACOs]. There is not now a unified definition for an ACO, but one is starting to take shape.

ACOs are healthcare delivery models composed of groups of providers responsible for managing a defined population of patients. These ACOs will be accountable for the quality and cost of care delivered to that population and will also need to distribute dollars equally across these providers.

Financial relationships must not only support the infrastructure needed to provide services, but also need to show enough gain to stakeholders—primary care physicians, specialty physicians, hospitals, nursing homes, rehabilitation, home health agencies, etc.—to incentify performance.

There are a few successful examples of ACOs, such as the Geisinger Clinic. They are the exceptions, not the norm. The private sector demands to control healthcare costs will increase pressure to organize ACOs. This will present new challenges and opportunities for physi­cians, who will need to organize to take a lead role in determining what is best for our health delivery systems.

The Centers for Medicare and Medicaid Services (CMS) has predicted that regulations clarifying the scope and requirements for ACOs will be published in the fall of 2010.

Additionally, the Federal Trade Commission (FTC) and CMS will co-host a workshop on issues associated with ACOs at the CMS Headquarters in Baltimore in October. The workshop addressed public comments on the legal issues that have arisen such as: antitrust, physician self-referral, anti-kickback, and civil and monetary penalty laws related to ACOs.

On Friday, October 22, the Pennsylvania Medical Society will hold a seminar titled “Get in the Game: Why Physicians Must Engage in This Era of Change” to educate physicians about ACOs and the need to take a leadership role in devel­oping new healthcare delivery models. Alice Gosfield, Esquire, a well-known physician advocate, will lead a discus­sion featuring panelists experienced in promoting and benefiting from physician leadership. The goal is to equip partici­pants with the information and strategies necessary to understand why physician leadership in the evolving healthcare delivery system is critical to their own business case for quality and their success in the new healthcare environment.

I believe that it is the duty of all physi­cians to work together and to be actively engaged to lead this transformation of health­care. We cannot stand by and allow others, many of whom have limited knowledge of the world of medicine, to determine its future. At the end of the day, the only profession that can make individual complex decisions about how to provide quality care while concur­rently reducing cost is US. The physician’s pen drives costs and quality. Therefore, we must play a leading role in the development and design of regional ACOs.

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Dr. Cacciamani is President of the Philadelphia County Medical Society.

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