Accountable care organizations are groups of physicians, hospitals and other healthcare providers who come together voluntarily to give coordinated high quality care.
As of December 2015, there are 782 privately-owned ACOs, covering 23 million lives.
Here are 12 things for ASC leaders to know:
1. The three biggest ACOs are Advocate Partners in Chicago, Partners HealthCare in Boston and Alina Health in Minneapolis.
2. There are a few advantages for providers to join under an ACO model. There's a lower cost of care, a convenient site of care and physician alignment. Moving some procedures from the hospital outpatient department setting to the ASC setting can contribute to ACO savings.
3. Though ACOs generate savings by limiting avoidable billings, they must still offer superior customer service to effectively compete for patients. ASCs are known as efficient, cost-effective facilities that can provide quality care, therefore serving as a strong competitive asset for ACOs.
4. An independent ASC in a very large multi-hospital system community or a small town dominated by one or two hospitals may not fit into the ACO structure. Powerful hospital systems controlling the ACO could cut ASCs out regardless of potential savings. When independent physician groups manage the ACO, they're more likely to benefit from an ASC's savings.
5. If surgeons in the community join a hospital-driven ACO, they may no longer be able to bring cases to the ASC. One way to minimize these situations is by strengthening the relationships between the ASC and its hospital/physician partners.
6. Released in late 2011, federal enforcement agencies issued two waivers that exempt ACOs from prosecution under existing healthcare regulations and affects ASCs both within and outside of the ACO. The first waiver, involving antitrust laws, allows ACOs to bring together normally competing providers — potentially ASCs — to coordinate care.
The second waiver, involving healthcare fraud and abuse laws, incentivizes physicians to use new approaches to patient care, which might include referrals to ASCs.
7. Federal enforcement lawyers specializing in the different areas of the waivers said, under the first waiver, surgery centers will be able to share certain pricing information that is normally kept confidential. However, even if ASCs do not join their local ACO, the waiver affords them protections against the ACO's market power. According to these lawyers, the second waiver allows the ACO to use its "shared savings" payments to reward providers to use more effective forms of care.
8. ASC owners and operators considering ACO participation first consider:
- How much does it cost to perform the procedure? If a leader knows the global expense, they'll be able to negotiate reasonable rates.
- Make sure the profit margin will more often than not cover these costs.
- Clearly outline with the payer and other ACO partners appropriate patients for the ACO to avoid incurring extra costs.
9. Specialists can currently participate in more than one ACO; becoming exclusive with one ACO limits the potential for future growth.
10. If there are multiple ASCs within the ACO, there are mixed incentives. For example, leaders don't want the ACO to pit ASCs against each other to push payment down too low.
11. If the ACOs target patient population is Medicare or another charity group, it may not be beneficial for the surgery center that currently has low Medicare representation in the payer mix.
12. It's problematic if a leader's center's electronic communication can't communicate with other providers in the ACO. The center may be forced to purchase a new system or additional technical capabilities to communicate within the ACO, which is a considerable expense for most centers, ranging from $15,000 to $70,000 per provider depending on whether the EHR-deployment is onsite or web-based.