The accountable care organization (ACO) is one of the lead cars of the broader fee-for-value train that has left the station. A little over a year ago, when the definition of an ACO was still a work in process, some likened an ACO to the mythical unicorn, and in certain quarters of health care, the ACO fell into disfavor, with some choosing to use clinical integration network as a less controversial term. The proposed rule for the Medicare Shared Savings Program (MSSP), issued at the end of March 2011, was lengthy, highly detailed, and mind-numbingly complex, and during its public comment period, it received much criticism and a phenomenal number of recommended changes. At the beginning of the summer of 2011, it seemed like the ACO concept might be dead.
But what a difference a year makes. The final rule for the MSSP, issued in October 2011—although still lengthy, detailed, and complex—was more generous and flexible for providers.
It received uniformly positive reviews by provider associations.
Richard Umbdenstock, president and CEO of the American Hospital Association, commented, “We commend the Centers for Medicare & Medicaid Services [CMS] for listening to the concern of America’s hospitals. The hospital field is actively working on ways to improve care delivery and the final ACO rule provides hospitals a better path to do so.
Similarly, then-president of the American Medical Association (AMA) Peter Carmel, MD, stated, “We are pleased that the final rule on Medicare ACOs includes many of the important changes recommended by the AMA to allow all interested physicians to lead and participate in these new models of care.
Commending CMS for its responsiveness to suggested changes, Donald Fisher, PhD, president and CEO of the American Medical Group Association, said, “We are optimistic that the model will get rolled out nationally on Jan. 1, 2012, with sufficient participation to allow the promise of this ideal of better, less costly, more coordinated care … [to] become a reality over time.
Glen Stream, MD, president of the American Academy of Family Physicians, echoed the other leaders’ comments, stating, “The Medicare ACO final rule recently released by the CMS represents a substantial step toward mending America’s broken healthcare system. The final rule sets the stage for transforming the way patients receive care and promises to end the fragmentation, duplication, and miscommunication that contribute to poor care and high costs.
The Growth of Medicare ACOs
In December 2011, two months after the publication of the final rule on the MSSP, the CMS Innovation Center announced the launch of a different, more aggressive ACO program with both upside and downside financial risks—the Pioneer ACO model—and the selection of 32 Pioneer ACOs, a group of experienced provider organizations. Many of the Pioneers are clustered in the Northeast, the Great Lakes region, and Southern California. As clear indications of the high degree of interest in this program, CMS received more than 160 letters of intent and more than 80 applications to the Pioneer ACO model.
Then in April 2012, CMS announced the formation of 27 MSSP ACOs, and three months later, the agency launched 88 additional MSSP ACOs. At present, with the six Physician Group Practice Transition Demonstration organizations that started in January 2011, there are in total 153 organizations participating in Medicare shared savings initiatives, providing care to more than 2.4 million beneficiaries.
Furthermore, CMS has indicated that more than 400 organizations have expressed an intention to apply for one of the Medicare ACO programs in 2013.
Commercial ACOs
In addition to the Medicare ACOs, during the past few years, most of the major health plans—including Aetna, members of the Blue Cross Blue Shield Association (notably Blue Shield of California and Blue Cross Blue Shield of Illinois), Cigna, Humana, and United Healthcare—have been developing commercial payer-led ACOs. Today, conservatively speaking, there are 150 to 200 commercial ACOs at various stages of development.
Not a Target for Repeal
Congressional Republicans and Republican presidential candidate Mitt Romney have said they will work to repeal the ACA. As originally specified by attorney Keith Hennessey, to accomplish a repeal, the Republicans would need to win the presidency, exit the upcoming election with at least 50 seats in the Senate (gaining at a minimum three seats), and maintain their majority in the House.
Source:Healthcare Financial Management Association
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