By: Jessica Green
By: Jessica Green
As part of The Affordable Care Act, Congress outlined a new healthcare system, Accountable Care Organizations (ACO). An ACO is a group of healthcare providers that share patient information in order to reduce mistakes and repetition of paperwork or tests, thereby lowering cost and improving the focus on the health of the patient. In order to become an ACO, a group of physicians must agree to care for at least 5,000 Medicare beneficiaries for a period of at least three years (Gold, 2012). The government has offered ACOs a portion of the money if they succeed in generating savings and in meeting 33 quality benchmarks under the Medicare Shared Savings Program (MSSP). Previously, under the Medicare fee-for-service program, physicians were paid for each service they provided to a Medicare patient. The more tests and treatments a physician ordered, the more money they got paid (Accountable Care Organizations, 2012). While the fee-for-service program is still running, MSSP is meant to lessen the likelihood of unnecessary or duplicate tests and treatments. Jenny Gold of Kaiser Health News says, “In other words, providers would get paid more for keeping their patients healthy and out of the hospitals” (Gold).
The U.S. Department of Health and Human Services chose 89 new ACOs on July 1, 2012. These new ACOs will provide care for 1.2 million Medicare beneficiaries in 40 states. The ACO and MSSP started with 32 Pioneer ACOs in December 2011 and six Physician Group Practice Transition Demonstration organizations in January 2012. In April 2012, 27 more were added. This makes a total of 154 ACOs across the country covering 2.4 million Medicare beneficiaries (Accountable). “This new group of ACOs adds to a solid foundation,” says Centers for Medicare & Medicaid (CMS) Acting Administrator Marilyn Tavenner. Health and Human Services Secretary Kathleen Sebelius predicts that this total number will save the Federal government $960 million over the next four years (Gold). Five of the new 89 ACOs applied to earn a higher share of the savings by also sharing in any losses if they do not succeed in lowering costs (Accountable).