Accountable Care Organizations: good for emergency medicine?
Posted by CEP America on Fri, Jul 02, 2010 @ 07:45 AM
By Ellis Weeker, MD
Those of us in emergency medicine have been hearing a lot about Accountable Care Organizations (ACOs). The accountable care organization model has taken on far greater significance since being unveiled as one of Medicare's pilot programs in the Senate's health reform bill.
In an ACO, groups of providers share a financial incentive to control costs and improve quality by closely coordinating care. By being reimbursed a fixed fee for the entire care of such select medical issues as a heart attack or a car accident, providers have financial incentives to keep costs down and quality up.
For example, ACOs would not receive additional payments if a person is readmitted for that same medical episode within 30 days. Theoretically, this encourages providers to eliminate medical errors.
Some people say ACOs are nothing more than HMOs in disguise. But when you dig a little deeper, there are differences:
- The "accountability" rests with the providers. Providers or provider groups, rather than insurance companies, are evaluated on the quality and efficiency of care.
- Physicians can contract directly with provider organizations without the reliance on a health plan intermediary.
- The ACOs allow for flexibility in the type of organization. Some regions may prefer independent practice associations (IPAs) while othersmay prefer a physician-hospital organization (PHO).
So what does this mean to an emergency physician or emergency department? In my view there is risk and opportunity. Single specialty groups such as emergency physicians could find themselves contracting with ACOs instead of hospitals or insurance companies in the future. If they do, they must make sure they are at the negotiating table whenever possible.
If the local IPA moves in this direction, emergency physicians should seek to become part of the governance structure in order to have a voice. If not, we will have as little control as we currently have by contracting with the insurers. If we do, we might actually increase our influence!
Whether the ACO model is the panacea for runaway heath care costs remains uncertain. What is certain is that our current fragmented system incentivizes providers to offer neither cost-effective nor coordinated care. The status quo has got to go.
What are your thoughts on accountable care organizations? Please send me your comments.