An Accountable Care Organization (ACO) is a local group of Medicare providers tasked with providing quality, low-cost health care to a specific population of patients. They are either physician or hospital led and are responsible for the care of at least 5,000 Medicare patients over at least a three-year term. During that time, quality and cost control measures are reported to Centers for Medicare and Medicaid Services (CMS) for analysis under the Medicare Shared Savings Program (MSSP.)
ACOs are participants in a government administered program (MSSP) to reduce costs and increase quality of care to government insurance beneficiaries. It is not a private, for profit network of providers interested in reducing costs to increase profits. Those networks are Managed Care Organizations such as HMOs and PPOs. The savings with an ACO are directly reimbursed to the providers in the form of incentives and monitored and administered by CMS. If the savings are not realized, then the providers are not out anything other than the normal reduction in fees from the Medicare fee schedule they are subject to.
ACOs are local because they are dependent on geographic factors such as number of providers, reimbursement rates, a controlled patient population, and specific patient referral patterns. Each provider in the ACO is responsible for a good outcome for that population of Medicare patients (5,000 or more.)
Optometrists are in a good position to participate in ACOs (although not required to) because of the cost-effective and patient-centered nature of primary eye care. The optometrists most likely to participate first are ones employed by ophthalmology and hospital groups. Large group practices with multiple locations and easy access to technology and exchange of information will likely be asked to participate as well.
In today’s changing health care environment, what is the best plan for a private practice to adapt, thrive and balance? Health care reform experts agree that moving forward, the best strategy is the one that got optometry to an equal footing in the first place – patient education and physician relations:
- Nurturing relationships with primary care providers
- Improve ability to provide emergent care and access
- Become proficient at identifying and co-managing early signs of system diseases
- Increase patient education efforts about eye diseases, injuries, and prevention
- Promote wellness exams, early intervention, and technology
- Use all media to educate patients about the role of an optometrist in their overall health plan
- Report PQRS, CQM and Meaningful Use measures consistently and proficiently
- Use EHR and exchange of patient data systems successfully and consistently
ACOs are a voluntary and fairly new approach to controlling costs for an aging US population with a growing need for affordable, quality health care. While it may not be the only answer, the program does remain a growing and influential way healthy care will be delivered in the future. Private practices need to be taking steps now to understand them and participate.
