This is my first blog post on the OIMA Web page.
What is an ACO, and am I in one??
ACO is the abbreviation for Accountable Care Organization. This buzzword means that an Organization has agreed to Care for a Defined Population and have its care Measured. I will explain what that all means.
In the Marcus Welby era, the local doctor cared for his or her patients, but there was little oversight or accountability. Back in those days, even malpractice was not a word primary care docs had to worry about. As we have moved forward, we find that some doctors see large numbers of patients, spend little time with them, and have the mindset that if the patient wants to be cared for, he should make an appointment and be seen. Medical bills are paid by insurers or Medicare, and the prices have been flat for years as the cost of maintaining an office has risen. The only way to make money is to see more and more patients in a day. Unfortunately, for some physicians, this has led to an urgent care mentality in which the simple problems are addressed, but the time-consuming difficult ones are put off. When overlords then assess the Quality of the care being paid for, it is often lacking. Diabetics have uncontrolled blood sugars, obesity rates rise, hypertensives have uncontrolled blood pressures, common cancers are not screened for...the list goes on and on.
CMS, medicare, is now moving relentlessly away from "volume" of care to "quality" of care. Doctors now are required to measure and document how well they are caring for their patients. More and more money will be allocated to the "quality" pot and less and less to the "how many patients can you see" pot over the next 3 years.
In order to "measure" the quality of care, an electronic medical record is usually needed. Many of these systems have proliferated in the last 10 years and some are not user-friendly. Hence, some doctors spend most of their time in the office looking at a computer screen rather than the patient sitting in the room.
The other big change is that a "population" is anyone seen by the doctor in 3 years, so if a person with diabetes chooses not to be seen for a couple of years, the doctor is still responsible for the care. This has led to systems and processes designed to recognize gaps in care: no mammogram in 3 yrs, no colon cancer screening, no flu shot, etc, etc. Patients will need to be contacted and appointments made for them to at least try to get them to comply with national recommendations.
Mercy Health had the foresight several years ago to recognize that significant changes were coming and devoted millions of dollars to set up systems to track and measure the quality of care in its statewide network of physicians and hospitals. The ACO network now consists of a large number of employed and affiliated physicians. Besides locations in Kentucky, Cinncinnati, Lima, Toledo, Springfield and Lorain, the network now includes SummaHealth in Akron, and Metro hospital system in Cleveland. Primary care physicians are practicing in teams with increasing attention paid to care coordination and behavioral health. Cost of care is also important as more and more people are forced to pay out of pocket for medical costs. Having a well-coordinated network of primary and specialty physicians should help keep costs in line as well as focus on quality of care AND with patient satisfaction with that care.
So, if you are a patient of mine or Molly, you ARE in an ACO. Our goal is to keep the best parts of Marcus Welby, but also to practice at the highest standard and be able to show that we are achieving quality care.