Healthcare Performance Benchmarks
Healthcare Performance Benchmarks
February 9, 2011Vol. I. No. 5

Who's Eligible to be an ACO?

ACO Eligibility

In this week's issue, learn which organization types are eligible to become ACOs.

This week's challenge: The healthcare reform law provides for accountable care organizations (ACOs), a group of healthcare providers that agrees to be accountable for the quality, cost and overall care of assigned Medicare beneficiaries. We wanted to see the five types of organizations eligible to be ACOs under the CMS Shared Savings Program. Click here to view a printable version of the chart.

What We Learned: "Buried within the 1,000-plus pages of the federal healthcare reform legislation is a provision known as the Shared Savings Program. What it requires is that no later than January 1, 2012, the HHS secretary must establish a Shared Savings Program specifically relating to ACOs, which comes from the statute. Itís an organization of healthcare providers that agrees to be accountable for the quality, cost and overall care of assigned Medicare beneficiaries who are enrolled in the traditional FFS program. The statute also specifies five categories of organizations that are eligible to become ACOs. The first four categories are all physician-driven; the fifth category, which is a catchall category, reserves onto the secretary the authority to determine other and additional appropriate organizations that would be eligible. Whatís clear from this aspect of the statute is that physicians can become ACOs without hospitals, but hospitals cannot become an ACO-eligible organization without physicians."

Source: Jeffrey R. Ruggiero, Esq., a partner in the law firm of Arnold & Porter LLP and legal advisor to the Queens County Medical Society.

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Blueprint for ACO Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization

Excerpted from Blueprint for ACO Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization, a 40-page resource that will prepare healthcare organizations considering an ACO for clinical and regulatory success. First, it details Advocate Physician Partners' clinical integration (CI) program, from the structure of the CI group to funding, incentives, mechanisms and technology that support CI, and why a successful CI program can provide the ACO foundation. Next, a legal advisor for the Queens County Medical Society ACO launch describes the operational and regulatory compliance requirements that must be met to ensure a highly cost-effective, high quality, safe and legally compliant ACO for patients and health plan members.

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