Attention To Surgeons And Surgical Care Is Largely Missing From Early Medicare Accountable Care Organizations

Abstract

The Affordable Care Act supports the growth of accountable care organizations (ACOs) as a potentially powerful model for health care delivery and payment. The model focuses on primary care. However, surgeons and other specialists have a large role to play in caring for ACOs' patients. No studies have yet investigated the role of surgical care in the ACO model. Using case studies and a survey, we examined the early experience of fifty-nine Medicare-approved ACOs in providing surgical care. We found that ACOs have so far devoted little attention to surgical care. Instead, they have emphasized coordinating care for patients with chronic conditions and reducing unnecessary hospital readmissions and ED visits. In the years to come, ACOs will likely focus more on surgical care. Some ACOs have the ability to affect surgical practice patterns through referral pressures, but local market conditions may limit ACOs' abilities to alter surgeons' behavior. Policy makers, ACO administrators, and surgeons need to be aware of these trends because they have the potential to affect the surgical care provided to ACO patients as well as the success of ACOs themselves.A ccountable care organizations (ACOs) are a new and potentially powerful payment model authorized by the Affordable Care Act. In ACOs approved by the Centers for Medicare and Medicaid Services (CMS), groups of physicians, together with other possible partners such as hospitals, take responsibility for the cost and quality of care for a set of Medicare patients and share in the savings if total costs are reduced below the benchmarked, expected costs. ACOs are designed to provide incentives for cost savings without limiting patient choice or compromising the quality of care.CMS approved the first fifty-nine Medicare ACOs in 2012. The agency is overseeing two different ACO models under its Medicare Shared Savings Program and the Pioneer ACO program. The programs differ primarily in terms of how much risk the ACOs in them assume.1 An Advance Payment Model that is part of the Shared Savings Program offers capital assistance to ACOs without inpatient facilities and with annual revenues of less than $50 million and to rural ACOs with critical-access hospitals, low-volume hospitals, or both and with annual revenues of less than $80 million.2 Many ACO-like arrangements have appeared in the private sector as well.Patients are attributed to an ACO if they obtain a plurality of their care from a primary care physician in the ACO. Medicare tracks the performance of individual ACOs against cost and quality benchmarks for the beneficiaries attributed to them.

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations

“…While a handful of studies have examined the involvement of particular types of providers in ACOs (e.g. hospitals or community health centers) and associated issues of partnering with those organizations, 1–4 these studies cannot provide broader insight into the phenomenon of providers partnering under ACO contracts. In this paper, we address this gap in the literature by using mixed methods analysis (survey data, performance data, and semi-structured interviews) to describe the landscape of new partnerships between health care provider organizations associated with ACOs.…”

Variation in Specialty Outpatient Care Patterns in the Medicare Population

“…Despite suggestions that management of specialist referrals may be an important path to savings, 18,42 engagement with specialists has been limited. 43 Significant barriers exist in that the majority of specialty care is provided by physicians that are not part of the ACO. 44 For specialists participating in ACOs, revenue generated through the ACO typically accounts for a small percentage of total revenue, 45 potentially limiting their desire to develop innovative models of care financed through possible shared savings.…”

Creating Highly Reliable Accountable Care Organizations

“…Specifically, Dupree et al (2014) found that care coordination is seen as critical, with 86% of their survey respondents emphasizing the importance of avoiding wasted at LAURENTIAN UNIV LIBRARY on June 4, 2016 mcr.sagepub.com Downloaded from resources due to poor care coordination. Leaders of ACOs are also charged with creating a context and transmitting the incentives to ensure that the combined organization diligently pursues cost reduction, quality improvement, and population health.…”