Primary care docs issue blueprint for ACOs
Four organizations representing some 350,000 primary care physicians in the U.S. released last month guidance on the structure of accountable care organizations (ACOs) and the possible payment models to make them successful.

The four groups are American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and the American Osteopathic Association.

The organizations have sent their joint principles to the Centers for Medicare & Medicaid Services (CMS) to encourage their use as CMS outlines ACO demonstration projects, as well as to guide related ACO activities offered through the newly established CMS Center for Medicare and Medicaid Innovation.

"Primary care should be the foundation of any ACO and the recognized patient and/or family-centered medical home is the model that all ACOs should adopt for building their primary care base," according to the joint principles.

In a statement sent to Cardiovascular Business News, the American College of Cardiology (ACC) said, "Outside of integrated systems, the U.S. has a serious problem in poor coordination of care between inpatient and outpatient and primary and specialty care, resulting in poor management of chronic disease, and uneven prevention and quality of care.

"The medical home concept is a positive potential remedy for this unsafe shortcoming, but it's tricky. The increasing shortage of primary care clinicians means a significant number of medical homes for certain patients, like those with serious heart failure, will need to be in specialty practice settings if they are to exist and be effective. The current patient-centered medical home discussion isn't yet facing this.

"The patient-centered medical home shouldn't be looked at as a means to increase the role of the primary care physician. The concept the American Academy of Pediatrics endorses of a team where specialists serve crucial roles and in some circumstances even serve as the main coordinator is what is needed."

The Medicare Payment Advisory Commission has called for the testing of ACOs and the recently passed healthcare reform legislation allows physicians and other healthcare professionals to organize as ACOs under Medicare beginning in 2012.

Regarding the structure of ACOs, the joint principles include:
  • Nationally accepted, reliable and validated clinical measures are used to measure performance and efficiency and evaluate patient experience;
  • ACOs implement clinically integrated information systems to provide relevant information at the point of care and assist in care coordination;
  • Barriers to small practice participation are addressed and eliminated; and
  • ACOs are adequately protected from existing antitrust, gainsharing, and similar laws that currently restrict the ability of providers to coordinate care and collaborate on payment models.

Regarding payment, the principles include:
  • The payment models recognize effort required to involve family, community/educational resources and other pertinent entities and activities related to care management/care coordination of patients with complex conditions;
  • Recognition and rewards for the ACO's performance are based on processes that combine achievement relative to set target levels of performance;
  • Practices participating within ACOs that achieve recognition as medical homes by nationally accepted certification entities should receive additional financial incentives; and
  • ACOs employ a variety of payment approaches to align the incentives for improving quality and enhancing efficiency while reducing overall costs.

The joint principles can be found here.