Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Health care coordination under the rules of an ACO

Donald Tex Bryant
Policy
May 9, 2011
28 Shares
Share
Tweet
Share

On March 31, 2011 CMS issued its proposed rules for Accountable Care Organizations (over 400 pages).

There is now a 60-day comment period.  Shortly thereafter, the final rules will be issued.  I am sure there will be changes in the proposed rules as there were changes in the “meaningful use” rules for electronic health records (EHR’s).  Yet, much of the intent of the proposed rule will probably remain unchanged and now is a good time for healthcare providers to begin adopting the processes, tools, measures and guidance laid out in the document, as the formation of ACO’s will probably be widespread.  It is likely that CMS will begin signing agreements with ACO organizations sometime in 2012.

Given the fact that many organizations are forming ACO structures now, I believe that it is important that physician practices and other healthcare organizations start planning for their arrival, both those groups planning to become a part of an ACO and those who are not planning on becoming a part of an ACO.  Most healthcare organizations will likely be impacted.  In West Michigan, where I live, the three major hospital/physician organizations are forming ACO’s and, as a result, will have a large impact on others who are not part of the structures.  The University of Michigan is involved in ACO’s and is providing faculty representatives at the second annual National Accountable Care Organization Summit.

Since the ACO structure will have a broad impact, let me lay out a few of its salient features, especially those that are related to quality and measuring quality.  First, with what kind of organizations will CMS sign an agreement as an ACO?  The proposed rule lists four types:

  • ACO professionals in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Hospitals employing ACO professionals
  • Such other groups of providers of services and suppliers as the Secretary of HHS deems necessary.

ACO professionals are defined as physicians, nurse practitioners, physician assistants and clinical nurse specialists.  From further reading, I am almost certain that CMS will not contract with an organization that does not supply primary care services to its patients.   CMS will certainly want primary care support for its beneficiaries who are in ACO organizations.

Next, what is the intent of CMS in signing agreements with an ACO organization?  It is as quoted from the proposed rules “to promote accountability for a population of Medicare beneficiaries, improve the coordination of FFS items and services, encourage investment of infrastructure and redesigned care processes for high quality and efficient care delivery, and incent higher value care.”  The provider must be patient-centered.  The rules draw upon the goals listed in the Institute of Medicine’s Crossing the Quality.  Namely, providers should supply care that is

  • Safe
  • Timely
  • Patient-centered
  • Effective
  • Efficient
  • Equitable

Based upon these goals, CMS has listed 65 indicators with accompanying descriptions of how they will measure the indicators.  CMS will grade providers on these outcomes based upon benchmarks from providers who are not in ACO organizations.  If the ACO exceeds these benchmarks significantly it will be rewarded financially for the savings that it provides CMS.  The 65 indicators will be adjusted for regional outcomes and on other factors which can impact the ACO.  Success in achieving the measures will be based upon the population level outcomes for patients of the ACO who are Medicare beneficiaries.

Some of the measures are:

  • Controlling cholesterol levels of the patients with coronary artery disease
  • Controlling blood pressure of patients with hypertension
  • Achieving patient satisfaction on a number of factors as measured by Clinical/Group CAHPS
  • Achieving A1c levels below 7% for diabetics

Providers will need to take a thorough examination of processes and population level outcomes to achieve these goals and make changes in their processes in order to reach the goals.  Advantage Health of Grand Rapids in conjunction with Saint Mary’s Health Services is becoming certified as patient-centered medical homes by NCQM in order to achieve the level of outcomes specified by CMS.  Dr. David Blair of Advantage Health and Roberta Jelinek of Saint Mary’s recently outlined this approach at the Michigan Medical Group Managers Association’s spring conference.  Another successful approach is to use a Lean Healthcare approach which is based upon the Toyota Production System and is becoming more widespread in healthcare as more individuals are being trained and certified in this area.

Let me end with a personal example of good coordination of healthcare services.  Usually after my annual physical I ask my physician to have his staff arrange an appointment with a dermatologist if he and I agree that there are some moles on me that are suspicious. Once my dermatologist is done with the exam, he verifies who my primary care physician is so that a summary of findings can be sent to him.  Also, my dermatologist calls me within two days with the results of any biopsy.  At my next annual exam, my physician reviews the dermatologist’s findings with me again.  I find it very encouraging that the dermatologist makes an extra effort to be sure my physician is up to date with the findings.  Under the rules of an ACO, such coordination will become commonplace.  Can your site achieve such outcomes?  I believe it will be necessary to do so soon.

Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Why medical students should go through a psychiatry rotation

May 9, 2011 Kevin 8
…
Next

Doctor bashing and confronting physicians in the media

May 9, 2011 Kevin 48
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
Why medical students should go through a psychiatry rotation
Next Post >
Doctor bashing and confronting physicians in the media

More by Donald Tex Bryant

  • a desk with keyboard and ipad with the kevinmd logo

    Providers should be active in helping patients follow directions

    Donald Tex Bryant
  • a desk with keyboard and ipad with the kevinmd logo

    Use the scientific method in the transition to ICD-10

    Donald Tex Bryant
  • a desk with keyboard and ipad with the kevinmd logo

    E-health initiatives that focus on patients can improve outcomes

    Donald Tex Bryant

More in Policy

  • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

    Ton La, Jr., MD, JD
  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

    Robert Pearl, MD
  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • Most Popular

  • Past Week

    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

      Veronica Bonales, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Workplace Harassment, Cyber Incivility High for Minority Groups in Academic Medicine
  • Superior Cognition in the Oldest-Old; Novel MS Pathway; What Links Amyloid and Tau?
  • Phase II Study: Bispecific Oral Drug Tops Leading JAK Inhibitor for RA
  • New Nonhormonal Hot Flash Recs; Global Plastics Treaty; SGLT2 & Lower Cancer Risk?
  • Leaky Impellas Recalled; Andexanet Alfa's Brain Bleed Win; Estrogen Pills & High BP

Meeting Coverage

  • Phase II Study: Bispecific Oral Drug Tops Leading JAK Inhibitor for RA
  • Closing the Diversity Gaps in Urologic Oncology Leadership
  • Certain NSCLC Patients May Be Able to Stop Immunotherapy at 2 Years
  • No Survival Benefit With Immune Checkpoint Inhibitor Rechallenge in Metastatic RCC
  • Happy Sleep, Happy Couple?
  • Most Popular

  • Past Week

    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

      Veronica Bonales, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Health care coordination under the rules of an ACO
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...