A Place for Anesthesiologists in Accountable Care Organizations (ACO)
Ron Evans, MPH, FACHE, FACMPE | Senior Healthcare Consultant
Future funding of the Patient Protection and Affordable Care Act (PPACA or ACA), more commonly known as Health Care Reform, is currently being challenged in Congress. As a result, some groups may be taking a wait and see attitude. Most hospitals, health systems and third party payers are not. There is ample evidence that regardless of the eventual funding of ACA in its entirety, many of the concepts and initiatives of the Act will survive. One of the key delivery system reforms encouraged by ACA is Accountable Care Organizations (ACOs). It represents a concept that will most likely survive any funding challenges to ACA.
- Providers need to become accountable for the overall quality and cost of care for the populations they serve.
- Provider incomes must be decoupled from volume and intensity of services performed; pay should reflect better value: improved outcomes, better quality and reduced costs.
- The ACO should adopt fully transparent and meaningful performance measures on both quality and cost. This is necessary to overcome patient resistance. Also, reliable risk-adjusted measures of overall costs are a required element so as to measure impact of care changes at the local level. 6
Implications for anesthesiologists
Depending on the type of entity developing an ACO, primary care physicians, hospitals or large integrated systems are seen as the major players in the ACO arena. Nevertheless, anesthesiologists have important roles to play in coordinating and managing care in the peri-operative period, improving efficiency and reliability of that care, and impacting procedural outcomes. The most important reason anesthesiologists should care about ACOs is the payment methodologies will substantially change in the ACO model from fee-for-service to one based on quality and efficiencies. If anesthesiologists do not actively participate in the process and contribute to its success, the result could mean unwelcomed, significant reductions in compensation.The ASA has been involved at the national level. In a White House meeting on December 17, 2010 focusing on patient safety and ACOs led by CMS Administrator Don Berwick, M.D., and Ezekiel Emmanuel M.D., Ph.D., President Obama’s Special Advisor for Health Policy at the Office of Management and Budget, ASA First Vice President John Zerwas, M.D., reported that his comments in this meeting centered on the role of anesthesiologists in the creation of ACO’s, stating, “We have a unique opportunity to lead because we care for patients through the entire peri-operative period, from admission through discharge. Eighty percent of the hospital costs come during the peri-operative period and anesthesiologists, who consistently manage the care of patients during this period, have the greatest opportunity to improve outcomes and lower costs.” Dr. Zerwas added, “As regulations covering ACOs and other delivery system reforms are written, the unique role of the anesthesiologist must be considered if improvements to patient care and cost reduction are to be fully realized.” 7 Involvement in the ACO process must percolate down to the state and local levels. Just as many hospitals, once fierce competitors, are now forming strategic alliances or merging into large integrated health delivery systems, the “strength in numbers” concept applies to individual anesthesia groups as well. When single payments for certain populations or for episodes of care become a reality under ACOs, all players in the healthcare arena (e.g., PCPs, specialists, ancillary providers, hospitals) will be vying for their share of those monies. Anesthesia groups must work to earn a place at the bargaining table, or as someone once said, they will find themselves on the menu!
1 Bricker & Bricker, Attorneys at Law. “The Health Reform Law Section-By-Section: Accountable Care Organizations, Section 3022 of ACA.” http://www.bricker.com/services/resource-details.aspx?resourceid=545
2 Fisher ES, Staiger DO, Bynum JP, Gottlieb DJ. “Creating accountable care organizations: the extended hospital medical staff.” Health Affairs (Millwood). 2007;26:w44-57.
3 Vuletich, Matthew. “Challenge of healthcare reform fires up MGMA CEO.” MGMA 2009 Annual Conference. October 13, 2009. http://www.mgma.com/article.aspx?id=30609
4 Fields, Rachel. “One Year Since Healthcare Reform: 5 Thoughts From Healthcare Leaders.” Becker’s Hospital Review. March 1, 2011. http://www.beckershospitalreview.com/hospital-financial-and-business-news/one-year-since-healthcare-reform-5-thoughts-from-healthcare-leaders.html
5 Gillespie, Greg. “Berwick Lauds Health Reform, Says ACO Rule is Imminent.” Health Data Management Breaking News. February 24, 2011. http://www.healthdatamanagement.com/news/HIMSS11_Berwick_health_reform-42021-1.html?ET=healthdatamanagement:e1678:112704a:&st=email&himss=himss
6 Fisher ES, McClellan MB, Bertko J et al. “Fostering accountable health care: moving forward in Medicare.” Health Affairs (Millwood). 2009;28:w219-31.
7 ASA Washington Alerts. “ASA Leadership Advances Interests of Anesthesiologists at White House Patient Safety and ACO Meeting.” ASA Website, December 20, 2010. http://www.asahq.org