CMS Releases Q&A on Accountable Care Organizations

The Centers for Medicare & Medicaid Services (CMS) has released a preliminary Q & A to start defining how accountable care organizations (ACOs) will work.

ACOs were included in the Patient Protection and Affordable Care Act and are set to start in 2012.

Click HERE to read the Q&A.

In the Q&A, CMS defines an ACO as “an organization of healthcare providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.”

In addition, CMS said ACOs can be physicians and other professionals in group practices or in networks of practices; partnerships or joint venture arrangements between hospitals and physicians/professionals; hospitals employing physicians/professionals; and other forms that the Secretary of Health and Human Services may determine appropriate.

Provider and doctor groups who band together for large cadres of patients would start seeing reimbursements as part of the ACO plan. If they are able to improve outcomes and lower costs then those ACOs can potentially share in the savings.

“Gainsharing within the ACO will allow sharing of cost savings provided by good quality care,” Edward R. Jones, MD, president of the Renal Physician Association, told Renal Business Today in a May article. “In addition, ACOs jointly formed by nephrologists, PCPs and other entities will allow for redistribution of cost savings to those providing the improved care.”

If organized correctly, ACOs could have the potential create a more cohesive line of care for patients, not starting when they need specialized care, but starting earlier when many chronic conditions have the potential to be staved off.