To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.
In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.
ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.
"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn't hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.
The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.
The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.
When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.
If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.
"Those that are not there today should start working towards it today," Dr. Davis said.