Accountable Care Organizations

As a part of healthcare reform there has been a lot of talk about the creation of Accountable Care Organizations, but what exactly are they, why are they so controversial, and what is their potential impact on the delivery of Emergency Medicine? 

Under the Affordable Care Act, ACOs have been created as a new payment model under Medicare.  There are also have pilot programs to extend the payment model to Medicaid and private insurance.  The goal of ACOs is to create a hospital and provider network that would provide care with quality and cost saving initiatives and CMS and the providers would share the cost savings.  The goal is to provide high quality care with reduced cost using a more integrated delivery approach and more aggressive quality monitoring.

ACOs may have some conflict with the traditional practice of Emergency Medicine in several ways.  First, physicians will become employees of ACOs.  Traditional Emergency Medicine doctors have the choice in some states to work as independent contractors.  Being an independent contractor allows them to provide access to care without a conflict of interest and without outside influence. 

ACOs may also conflict with laws in some states that prohibit the corporate practice of medicine. The CPM laws prohibit a hospital (or non-physician entity from directly hiring physicians).  CPM laws are designed to protect the physician patient relationship from conflict of interest, allowing doctors to be hired as independent contractors and to do what is best for the patient without undue influence. 

Although ACOs goals ares to to provide high quality integrated care at a lower cost, we will have to wait and watch closely to see what the overall effect truly will be.

New Affordable Care Act Tools Offer Incentives for Providers to Work Together When Caring for People with Medicare (October 20, 2011)   http://www.healthcare.gov/news/factsheets/2011/10/accountable-care10202011a.html

Fisher ES, Shortell SM (2010). Accountable Care Organizations: Accountable for What, to Whom, and How. JAMA 304 (15): 1715–1716.