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 ACO Process Moving Along, But Number Of Players Limited: Expert

 

 


A leading health care law and policy expert sees the implementation of accountable care organizations (ACOs) progressing, but suspects that ACOs are getting more attention than they deserve considering the relatively small number of provider groups expected to play in the space and more ambitious efforts being taken in bundled care and other government-led initiatives in the Medicare program.

David Harlow, founder and principal of The Harlow Group, and author of health care blog, HealthBlawg, http://healthblawg.com, says long term care providers should prepare for the changes coming to the Medicare world no matter if ACOs are involved or not.

“Especially with the thinner margins being seen today, it is important for providers to recognize no matter what it is called, ACO or otherwise, there is a movement underway away from fee-for-service to bundled payment and global payment systems,” Harlow says.

He said the sense is that many long term care providers are concerned about joining ACO-like groups out of fear of losing their independence, but those concerns need to be weighed against the changing tides in the health care business. Cementing ties between acute care and post-acute care providers would be good for both entities, Harlow says, with long term care providers being able to work with one or many hospital groups. “There is a real need for mom and pop [nursing homes] to get more sophisticated by moving to invest more in IT. To do this they will need some sort of infusion of funds from a larger organization,” he says.

“And at the same time, ACOs would do well to include various long term care providers.”

ACOs are part of a government effort under the health care reform law to allow Medicare beneficiaries to benefit from coordinated care, which is expected to improve care and save money by affiliating primary care doctors, specialists, hospitals, and other health care providers in patient care.

The final ACO rule that came out from the Centers for Medicare & Medicaid Services (CMS) in October answered a lot of stakeholder concerns about a draft proposal, but even with the changes in the final rule the footprint of organizations getting into ACOs is going to be small when compared to those involved in the Medicare program, he says.

“The final rule did a good job of making it easier for organizations to clear the regulatory hurdles,” Harlow says. Easier qualification rules, answers to anti-trust issues, and recognition of the progress being made in the private sector on ACOs were positives.

He said CMS projects that up to 250 organizations will be getting into ACOs over the next four years covering 2 million Medicare lives. That compares to the roughly 50 million covered under Medicare as a whole. The first wave of ACOs will come soon with those who qualified for the Pioneer ACO program, which is meant for provider groups that had already taken steps to form ACO-like structures before CMS acted.

A total of 32 groups were greenlighted by CMS in December to go live under the Pioneer program, Harlow says.

He said there is no number out yet on how many organizations are ready to form ACOs under the broader CMS ACO program.
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