While the fate of Obama Care hung in the balance, the ACO became the voluntary dance that nobody wanted to show up to too early. Defined by the Centers for Medicare and Medicaid Services (CMS) as “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it,” ACOs (Accountable Care Organizations) were promoted as a bigger, better model that allowed providers to get paid in a number of ways (capitation, fee-for-service, shared savings) in return for managing health at the population level across a broader swathe of the healthcare spectrum. But ACOs were tough, requiring greater accountability with providers having to report on 33 different performance measures to ensure they’re not skimping on care. And then there was the little issue of whether reform would be repealed and make it all null and void. Well, a mere week and a half after John Roberts cast the tiebreaker to make the individual mandate — and essentially, Obama Care — a reality, the ACO program has doubled in size. Eighty-nine participants joined 27 existing ACOs in the program. “The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives,” acting CMS Administrator Marilyn Tavenner said in a statement.
According to the CMS, the selected ACO programs operate in a range of areas nationwide and nearly half are physician-led organizations that serve fewer than 10,000 beneficiaries, which indicates smaller organizations are interested in participating. Four hundred more organizations have already submitted a notice of intent to apply next month, according to the CMS. The application period is Aug. 1-Sept. 6, 2012 for organizations that want to participate in the Medicare shared-savings program starting in January 2013.
Now that reform has the imprimatur of the Supreme Court judges, the next court that the Administration will have to focus its efforts on is the court of provider and public opinion. According to a survey of 24,000 U.S. physicians by Medscape, WebMD’s flagship site for medical professionals, only about 3% of physicians participate with ACOs ; only another 5% say that they plan to become involved in the coming year. 52% percent of physicians believe that ACOs will cause a decline in income, while 12% say they will have little or no effect. Overcoming that natural resistance to change may be the toughest part of putting the ACO in place.