AAFP Board Adopts Principles for Accountable Care Organizations
By Sheri Porter
Innovative ideas require scrutiny before they can be fully embraced, and a new model of health care delivery, known as the accountable care organization, or ACO, is no exception. That's why the model is being looked at by the AAFP, and why the AAFP Board of Directors recently adopted Accountable Care Organization Principles. (1-page PDF; About PDFs)
AAFP Director Kenneth Bertka, M.D., of Holland, Ohio, chair of the AAFP's ACO Task Force, told AAFP News Now that physicians might be unfamiliar with the term "ACO," even though it is sprinkled throughout health care reform legislation currently winding its way through Congress.
"The foundation of an ACO is primary care and the patient-centered medical home (PCMH)," said Bertka. The concept can be loosely defined as a primary care-based collaboration of health care professionals and health care facilities that accept joint responsibility and accountability for the quality and cost of care provided to a defined patient population, he said.
Think of the ACO as an extension of the PCMH, said Bertka. "The ACO can be that medical home 'neighborhood' that aligns all of the health care providers outside of the patient-centered medical home practice," he said.
However, it's possible that a proliferation of ACOs could thrust primary care into a scenario similar to the managed care environment of the late '80s and early '90s, when primary care physicians basically became a source of referrals for hospitals and subspecialists, said Bertka.
"Regardless of how one looks at it, the Board felt it really needed to get engaged," he said. If this is good for primary care, the AAFP will want to promote ACOs. However, if the concept holds too many negatives, especially for small- and medium-size family medicine practices, then the AAFP "absolutely wants to be at the table and have a hand in how ACOs are developed."
"The foundation of an ACO is primary care and the patient-centered medical home (PCMH)," said Bertka. The concept can be loosely defined as a primary care-based collaboration of health care professionals and health care facilities that accept joint responsibility and accountability for the quality and cost of care provided to a defined patient population, he said.
Think of the ACO as an extension of the PCMH, said Bertka. "The ACO can be that medical home 'neighborhood' that aligns all of the health care providers outside of the patient-centered medical home practice," he said.
However, it's possible that a proliferation of ACOs could thrust primary care into a scenario similar to the managed care environment of the late '80s and early '90s, when primary care physicians basically became a source of referrals for hospitals and subspecialists, said Bertka.
"Regardless of how one looks at it, the Board felt it really needed to get engaged," he said. If this is good for primary care, the AAFP will want to promote ACOs. However, if the concept holds too many negatives, especially for small- and medium-size family medicine practices, then the AAFP "absolutely wants to be at the table and have a hand in how ACOs are developed."
Outline of Principles
AAFP leaders adopted 16 of the principles recommended by the task force. According to these principles, ACOs must include, among other things,
- team-based primary care that involves a voluntary partnership of physicians and other participants;
- nationally accepted clinical measures by which performance can be measured;
- health information technology systems that provide point-of-care information and that assist care coordination among multiple providers;
- payment structures that are clearly identified and agreed upon by all members and that are monitored to prevent unintended consequences, such as denial of needed care;
- sufficient numbers of patients to enable accurate measurement of the level of care provided;
- participation options that allow physicians to be involved in multiple ACOs; and
- incentives to encourage patient engagement in health and wellness activities.
The principles also call for exploration of antitrust regulations and Stark self-referral regulations to allow for full physician participation.
Four additional principles relate to physician payment under the ACO model. Bertka said the final principle in the set is aimed specifically at primary care practices that participate in an ACO and that also hold a PCMH designation. The principle says that such primary care practices should be eligible for payments in both models of care.
"The PCMH needs to recognized, valued and rewarded for what it does," said Bertka. Any payments that are earned and awarded through the work of the entire ACO should be separate, he added.
Four additional principles relate to physician payment under the ACO model. Bertka said the final principle in the set is aimed specifically at primary care practices that participate in an ACO and that also hold a PCMH designation. The principle says that such primary care practices should be eligible for payments in both models of care.
"The PCMH needs to recognized, valued and rewarded for what it does," said Bertka. Any payments that are earned and awarded through the work of the entire ACO should be separate, he added.
Step-by-Step Process
Bertka advised family physicians to review the AAFP principles and to proceed cautiously before joining or creating an ACO.
"The ACO is really two steps out for most practices," said Bertka. The first challenge for most FPs is to become a high-performing practice regardless of how the health care reform debate shakes out.
"The second step is to prepare to become a patient-centered medical home for tomorrow, particularly when there is payment reform," said Bertka.
Finally, FPs should think about how their practices fit into the larger picture of working more effectively with other health care providers in the context of their medical home neighborhood, said Bertka.
"A significant portion of our members are going to find themselves in discussions around ACOs and other integrated delivery systems," said Bertka. But the concept is really just an extension of how FPs already relate to other specialists and consultants who assist in patient care, he noted. From a functional perspective, the ACO is just the team beyond the team in the physician's practice.
"The ACO is really two steps out for most practices," said Bertka. The first challenge for most FPs is to become a high-performing practice regardless of how the health care reform debate shakes out.
"The second step is to prepare to become a patient-centered medical home for tomorrow, particularly when there is payment reform," said Bertka.
Finally, FPs should think about how their practices fit into the larger picture of working more effectively with other health care providers in the context of their medical home neighborhood, said Bertka.
"A significant portion of our members are going to find themselves in discussions around ACOs and other integrated delivery systems," said Bertka. But the concept is really just an extension of how FPs already relate to other specialists and consultants who assist in patient care, he noted. From a functional perspective, the ACO is just the team beyond the team in the physician's practice.
Related ANN Coverage
Accountable Care Organizations Need Time to Develop, Mature
Entities Not Game Changers Yet, Study Says
(12/15/2009)
New Jersey Prepares to Launch Accountable Care Organization
Model Links Providers, Enables Them to Deliver Integrated Care
(8/26/2009)
More From AAFP
Patient-Centered Medical Home
How the AAFP is Supporting the PCMH Movement
Accountable Care Organizations Need Time to Develop, Mature
Entities Not Game Changers Yet, Study Says
(12/15/2009)
New Jersey Prepares to Launch Accountable Care Organization
Model Links Providers, Enables Them to Deliver Integrated Care
(8/26/2009)
More From AAFP
Patient-Centered Medical Home
How the AAFP is Supporting the PCMH Movement
