A burning question on the minds of many physician practices is whether they should become an accountable care organization (ACO). Practices throughout the United States are beginning to examine this care model and consider whether shifting to this approach is a good idea.
What is an ACO?
An ACO is a group of physicians and other healthcare providers—including hospitals—that work collaboratively and agree to accept shared accountability for the quality and cost of care they provide to patients.
ACOs can involve group practices, practice networks, hospital and practice partnerships, hospital-employed practitioners, and so on. The goal of the federal government and commercial payers in establishing ACOs is not only to improve the quality of healthcare but move reimbursement from a volume-based approach to a more value-based one.
Look Before Your Leap
Before embarking on the ACO path, it is important to take time to thoroughly understand what’s involved in becoming an ACO, so you are not caught unprepared for the complexity and potential expense associated with the transition. You may even discover that becoming an ACO is not right for your practice.
The following 10 questions can serve as a baseline for fact-finding and get you started in the information-gathering process.
- What quality metrics and standards do we need to meet in order to effectively function as an ACO?
- What reporting requirements do we need to meet in order to demonstrate cost and quality goals in order to receive reimbursement?
- Are we set up to meet these quality metrics and reporting requirements? If not, what would be involved in getting us there?
- What technology must we have to ensure adequate support for ACO operations?
- Do we need to hire additional staff?
- How will becoming an ACO impact our revenue cycle and the quality of patient care we provide?
- Should we be looking to partner with other practices or healthcare organizations, such as a hospital?
- How will any partnerships affect our practice financially and operationally?
- What timeframe is realistic for switching to an ACO?
- Should we try to make the switch on our own or should we seek outside assistance?
Becoming an ACO is not an easy process and practices should not engage in the effort lightly. Doing your due diligence is critical to ensure an appropriate, effective and smooth transition should you choose to become an ACO or justify your decision for remaining independent.