While ascendant GOP lawmakers and some 30 lawsuits seek to repeal the healthcare reform law, these efforts should not affect accountable care organizations, which are part of the law, according to speakers at the National Accountable Care Organization Congress in Los Angeles.
http://www.beckershospitalreview.com/hospital-physician-relationships/while-health-reform-faces-challenge-repeal-of-acos-unlikely.html
Accountable Care Organizations will be the nervous system of healthcare reform. Check back often to ACOinsight.com to stay abreast of all news and insight on ACOs.
Friday, October 29, 2010
JOHNSON: Patient beware of accountable care organization
ANALYSIS/OPINION:
There is much to dislike about this year's massive federal overhaul of the nation's health care system. One of Obamacare's potentially most dangerous — and least discussed — features is its call for government-sponsored accountable care organizations (ACOs).
http://www.washingtontimes.com/news/2010/oct/27/patient-beware-of-accountable-care-organization/
There is much to dislike about this year's massive federal overhaul of the nation's health care system. One of Obamacare's potentially most dangerous — and least discussed — features is its call for government-sponsored accountable care organizations (ACOs).
http://www.washingtontimes.com/news/2010/oct/27/patient-beware-of-accountable-care-organization/
Friday, October 22, 2010
Killing Marcus Welby
If ObamaCare really called for the creation of "death panels," the first victim of these in vented tribunals would have been Marcus Welby MD, the character in the hit 1960s television show that followed the daily dramas of a small-town family doctor. Read more: http://www.nypost.com/p/news/opinion/opedcolumnists/killing_marcus_welby_FLnABqCKwpyF9j2i9YYpCP#ixzz137PaapNg
5 Key Questions on How ACOs Will Function: From Robert Betka at Catalyst Management Advisors
The transition to accountable care organizations and shared savings is looking to be as dramatic as hospitals' shift to DRGs in the early 1980s, says Robert Betka Jr., a consultant with Catalyst Management Advisors in Grand Rapids, Mich. "This is a very exciting time," he says, noting federal authorities, private payors and ultimately ACOs themselves will have to answer some key questions on how the new system will operate. Here are five such questions.
1. How will the ACO be governed? A governing board made up of representatives from each partner would run the ACO. Would seats on the board be distributed based on each partner's significance in the organization? And how would the board interact with the governing boards of each component organization?
2. How does the ACO divide up payments? Initially, each component of the ACO would be paid on a fee-for-service basis and then would share a certain amount of the savings created by the ACO. How would that payment be divided? To determine this, Mr. Betka thinks clinical representatives from each component would have to identify the whole continuum of care for each condition and assign a value for each step in the continuum. For example, bypass surgery would involve surgery, imaging, nursing, rehabilitation and other services, depending on a variety of circumstances. While initially only the shared savings would be apportioned this way, eventually the whole payment would be broken down, Mr. Betka believes. The goal is to pay the ACO one lump sum for the entire episode of care, like a bundled payment, he says.
3. What would be the payment for prevention? ACOs with lower rates of expensive procedures would reward the specific caregivers responsible for this improvement. Mr. Betka this would often involve focusing on what did not occur, such as fewer surgeries due to better preventive care. For example, the shared savings for a lower rate of bypass operations might be apportioned to primary care physicians, cardiologists, dieticians and others who prevented a bypass operation from happening, he says.
4. How would accountability be identified? If there were an inappropriate readmission or a quality problem, would the ACO identify what component was responsible and assign the penalty to that component?
5. What is the role of healthcare IT? Making determinations on how to divide up payments, assign accountability and make care more efficient and safe would require very sophisticated healthcare IT. Computer systems would need to implement cost accounting, identifying the components of patient care and provide decision-support tools to analyze trends. However, only 7 percent of hospitals now have comprehensive electronic medical record systems.
1. How will the ACO be governed? A governing board made up of representatives from each partner would run the ACO. Would seats on the board be distributed based on each partner's significance in the organization? And how would the board interact with the governing boards of each component organization?
2. How does the ACO divide up payments? Initially, each component of the ACO would be paid on a fee-for-service basis and then would share a certain amount of the savings created by the ACO. How would that payment be divided? To determine this, Mr. Betka thinks clinical representatives from each component would have to identify the whole continuum of care for each condition and assign a value for each step in the continuum. For example, bypass surgery would involve surgery, imaging, nursing, rehabilitation and other services, depending on a variety of circumstances. While initially only the shared savings would be apportioned this way, eventually the whole payment would be broken down, Mr. Betka believes. The goal is to pay the ACO one lump sum for the entire episode of care, like a bundled payment, he says.
3. What would be the payment for prevention? ACOs with lower rates of expensive procedures would reward the specific caregivers responsible for this improvement. Mr. Betka this would often involve focusing on what did not occur, such as fewer surgeries due to better preventive care. For example, the shared savings for a lower rate of bypass operations might be apportioned to primary care physicians, cardiologists, dieticians and others who prevented a bypass operation from happening, he says.
4. How would accountability be identified? If there were an inappropriate readmission or a quality problem, would the ACO identify what component was responsible and assign the penalty to that component?
5. What is the role of healthcare IT? Making determinations on how to divide up payments, assign accountability and make care more efficient and safe would require very sophisticated healthcare IT. Computer systems would need to implement cost accounting, identifying the components of patient care and provide decision-support tools to analyze trends. However, only 7 percent of hospitals now have comprehensive electronic medical record systems.
Southeastern Wisconsin Health System, IPA Launch Accountable Care Organization
Southeastern Wisconsin's ProHealth Care and the local independent physician association Waukesha (Wis.) Elmbrook Health Care have formed the first accountable care organization in southeast Wisconsin, according to a Business Journal report.
The ACO will be launched in Jan. 2011 and will be called ProHealth Solutions. It is designed to participate in Medicare's new Shared Saving Program under the Patient Protection and Affordable Care Act.
The ACO will be a virtual community with one electronic medical record, and will include a comprehensive quality improvement program with technology that measures specific clinical and efficiency outcomes for each physician. Read the Business Journal report on southeastern Wisconsin's first ACO.
The ACO will be launched in Jan. 2011 and will be called ProHealth Solutions. It is designed to participate in Medicare's new Shared Saving Program under the Patient Protection and Affordable Care Act.
The ACO will be a virtual community with one electronic medical record, and will include a comprehensive quality improvement program with technology that measures specific clinical and efficiency outcomes for each physician. Read the Business Journal report on southeastern Wisconsin's first ACO.
Understanding Accountable Care Organizations
By 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.
http://www.physiciansnews.com/2010/10/13/understanding-accountable-care-organizations/
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.
http://www.physiciansnews.com/2010/10/13/understanding-accountable-care-organizations/
Don Berwick Comments on Goals for ACOs and Role of Federal Oversight
Kicking off a day-long federal listening session with stakeholders, CMS Administrator Don Berwick, MD, outlined his concept of the accountable care organization and how federal agencies should oversee ACOs.
He said federal regulators tailoring antitrust and fraud and abuse laws to accommodate ACOs have a fine line to walk. The legal goals for ACOs should be "cooperation without corruption, aggregation without hegemony and synergy without collusion," he said. In return, ACOs need "clarity and predictability about the regulatory regime."
http://www.beckershospitalreview.com/hospital-physician-relationships/don-berwick-comments-on-goals-for-acos-and-role-of-federal-oversight.html?sms_ss=linkedin&at_xt=4cb86983d1ac3fa8,0&goback=%2Egde_35964_member_32366730
He said federal regulators tailoring antitrust and fraud and abuse laws to accommodate ACOs have a fine line to walk. The legal goals for ACOs should be "cooperation without corruption, aggregation without hegemony and synergy without collusion," he said. In return, ACOs need "clarity and predictability about the regulatory regime."
http://www.beckershospitalreview.com/hospital-physician-relationships/don-berwick-comments-on-goals-for-acos-and-role-of-federal-oversight.html?sms_ss=linkedin&at_xt=4cb86983d1ac3fa8,0&goback=%2Egde_35964_member_32366730
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