Posted in Uncategorized

Un-bundling the Act: Provisions for ACOs

By Gregg A. Masters, MPH

We heard a lot about the rough life of Federal legislators when one of the material objections aka ‘talking points’ to actually considering the thoughtful remedies borne via public/private discourse and years if not decades of health policy development and experience outlined in the Patient Protection and Affordable Care Act was it’s weight and the corresponding number of pages found therein. After all an industry which represents 1/7th of the US Economy, consuming approximately $2.7 trillion in 2010, when compared to most if not all other industries seems to posses characteristics somewhat unresponsive to traditional marketplace demand and supply equilibrium. After all, few other industries create their own demand inside a rather complex and opague theater for such an essential human service.

As we sit poised for the decision on the constitutionality of the individual mandate, if not the Act in it’s entirety, why not take a summary look at both the provisions specific to ACOs, the balance of the Act, as well as it’s staged implementation timeline.

Courtesy of the Kaiser Family Foundation:

Accountable Care Organizations
Section 3022 of the Affordable Care Act

Allows providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.

Implementation: January 1, 2012

Implementation update: On April 7, 2011, the Department of Health and Human Services published a proposed rule in the Federal Register defining Accountable Care Organizations and set out requirements for governance, legal structure, transparency efforts and the incorporation of evidence-based medicine and quality efforts. HHS also released facts sheets for providers and consumers, as well as fact sheets on legal issues and quality scoring in ACOs. The Federal Trade Commission and Department of Justice issued a joint policy statement on antitrust issues related to ACOs. On May 20, 2011, CMS issued a request for applications for the Pioneer ACO Program, which is targeted at organizations that can demonstrate the improvements in quality and cost-savings of a mature ACO.

On December 19, 2011, CMS announced 32 health care organizations that will participate in the new Pioneer Accountable Care Organization project.

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