Accountable Care Organizations (ACOs)

Updated November 2012 

Accountable Care Organizations: What Do They Mean for Emergency Medicine?
An information paper developed by Members of the Emergency Medicine Practice Committee in September 2012.

Post-HMO Health Care: Are ACOs the Answer?
A May 2011 article on written by two emergency physicians.  

May 2011 -- The Centers for Medicare & Medicaid Services (CMS) released its draft regulations for Accountable Care Organizations (ACOs).

A summary of the highlights is now available online. According to the CMS announcement, “ACOs create incentives for health care providers to work together to treat an individual patient across care settings -- including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first.”

CMS fact sheet describes the proposals for what ACOs are, how they can be created, and other general topics. Additionally, other information on the CMS web site to addresses in greater detail specific aspects of the proposed rule, such as the quality measures and performance scoring.

Additional Information from CMS:

Other ACO Resources

Proposed Quality Measures for ACOs (Davis Wright Tremaine LLP, April 2011)
This is a short synopsis of the quality reporting requirements for ACOs. CMS sets a high bar in that ACOS must report on all 65, even in its first year. For a complete synthesis of draft rule highlights, click here.

What Are the Characteristics of a Successful Shared Savings Program? (The Commonwealth Fund, April 2011)

The ACA-Driven ACO Movement: Implications for Emergency Medicine (By Michael Gerardi, MD, FACEP; March 2011)

HHS Office of Inspector General Proposal for Waivers of Certain Federal Laws

FTC-DOJ Antitrust Policy Statement

Internal Revenue Service Guidance for Tax-exempt Organizations Seeking to Participate as ACOs

The Joint Commission Criteria for Primary Care Home Standards (Feb. 2011)

2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopters (Healthcare Intelligence Network, Feb. 2011)

Is There an ACO in Your Future? (MGMA Connexion, Medical Group Management Association, Jan. 2011)

Comment Letter from MedPAC (Nov. 2010)

Technology Fundamentals for Realizing ACO Success (Medicity, Sept. 2010)

Accountable Care Organizations in California: Lessons for the National Debate on Delivery System Reform (Integrated Healthcare Association, 2010)


ACO Creation Challenges

Top Challenges of ACO Creation
A February 2011 Accountable Care Organizations e-survey by the Healthcare Intelligence Network set out to assess the industry’s awareness of and readiness for ACOs.

Responses provided by 228 healthcare organizations, submitted before CMS released its proposed rule, indicate that a significant segment of the industry is reframing its care delivery structure as an ACO or will do so in the near future. According to respondents, the top five challenges of ACO creation are:

  • Cost (22 percent)
  • Staff/management buy-in (20 percent)
  • Other (18 percent)
  • Reimbursement (12 percent)
  • Evidence-based care (8 percent)





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