Amid the avalanche of all things ACO since the Centers for Medicare & Medicaid Services released its long-anticipated proposed rules on accountable care organizations last week, several recent articles point out that forming an ACO isn't necessarily attainable or desirable for all practices.
For starters, the proposed rule was written on the assumption that only 5 million Medicare beneficiaries--or 11 percent of beneficiaries--would participate in ACOs, notes Becker's Hospital Review. "On page 352, however, the guidance suggested a lower range of 1.5-4.0 million," noted the Deloitte Center for Health Solutions in its analysis of the 429-page document. Given this narrow affected patient population, analysts suggested that some practices may determine they're better off seeking other forms of integration, such as the creation of medical homes.
Further, the Deloitte Center claimed that, to achieve the scalability necessary to work, an ACO would likely need to cover at least 20,000 Medicare beneficiaries, a far cry from the 5,000 minimum set in the law.
A recent piece in the Wall Street Journal concurs, noting that one of the only existing ACOs, Atrius Health of Newton, Mass., is able to cover the difference when a patient's care exceeds the payer's limit using reimbursements from the fee-for-service half of its 800-physician group serving 700,000 patients. "The group has enough scale that it is able to improve quality, wring out waste and absorb losses on certain cases," the article states.
Because of these complexities, the American Academy of Family Physicians, together with six constituent chapters and the N.C.-based law firm of Smith Anderson, has compiled several resource documents to help its members understand the ACO model.
One piece, titled "The Family Physician's Practice Affiliation Guide," analyzes the reasons behind the trends, explores the pros and cons of various options and gives a thorough analysis of the hospital employment model, AAFP News Now reports. According to the guide's introduction, "There are compelling 'offensive' and 'defensive' reasons to consider integration and specific guideposts to assure a successful and sustainable partnership."
To learn more:
- read the article from Becker's Hospital Review
- see this article from the Wall Street Journal
- check out this piece from AAFP News Now
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