On Thursday, March 31, 2011, the Administrator for Centers for Medicare and Medicaid Services (CMS), Dr. Donald Berwick, conducted an invitational nationwide conference call to announce a new, proposed rule. He began the call by saying that health care is “fragmented,” and that the current fee-for-service system serves to reinforce this fragmentation. Patients are left to navigate independently through the system, leading to confused and poorly served patients.
The cure, according to Berwick, is integrated systems of care which include electronic medical records that can be shared among health care providers, as well as patient navigation and care management or case management services. The solution for the system as well as for patients is the Accountable Care Organization (ACO).
The goals of the ACO are to: 1) deliver seamless quality care, 2) increase patient choice, 3) facilitate medical partnerships in local communities, and 4) reduce the cost of care while improving patient health. When ACOs thrive patients will see:
- Care coordinated between hospitals, primary care physicians and specialists all facilitated by shared electronic health records;
- Support from discharge transition teams, including home health workers and care managers who will provide follow up care and reminders for periodic care (annual checkups, etc.);
- Continued opportunity to choose providers; and
- The opportunity to complete a quality of care questionnaire every year.
This proposed rule is one of the first opportunities to implement the Affordable Care Act (Section 3022), and is particularly aimed at Medicare. The rule includes provisions for ACOs to become part of a Shared Savings Program, which makes them eligible for payments in addition to traditional Medicare fee-for-service payments under Parts A and B, and is based on meeting specified quality and savings requirements.
ACOs can be flexible within the law to accommodate whatever works for the patient, as there are other payers who may also develop other types of plans. If Medicare services are already provided through another local arrangement, the arrangement will not change as a result of the rule. An ACO is not the only form of “bundled care”—other models have been in use in various places across the country.
CMS is requesting comment on the rule over the next 60 days following the April 7, 2011 scheduled date of publication, and ending on June 6, 2011. Final publication of the rule is anticipated to happen in September 2011.
For more comprehensive information on ACOs and how they will function, The Accountable Care News has published an April 2011 special edition on ACO regulation and guidance.