While not often in the mainstream media coverage, among the Affordable Care Act provisions that promise to bring substantive improvements in care quality is the accountable care organization.

Now that the ACA is constitutional, the uncertainty over, the road has been cleared for existing and would-be ACOs to align with CMS’ Shared Savings Program.

Government Health IT Editor Tom Sullivan spoke with Donald Fisher, CEO of the American Medical Group Association about what that means for patients and physicians, the most important tweaks to make to the ACA moving forward, and what the ruling might mean in the November elections.

Q: What’s the general reaction from AMGA members, any surprise?
A: There’s a bit of surprise. On the one hand it’s a tax, on the other hand it’s not a tax. We support the decision and accept it. Members of the AMGA have been moving to transform the healthcare delivery system for decades, working very hard to align high-quality care that’s coordinated across all locations. So the marketplace is driving reform of the healthcare delivery system and that’s going to proceed. I don’t think it changes much.

Q: There’s been so much uncertainty about the law and now at least healthcare practices know what to expect – so what does that change?
A: Many of the larger entities were moving forward to become accountable care organizations with the commercial payers and not Medicaid or Medicare. With this ruling and those provisions of the law intact, I think now the large integrated delivery systems will move much more quickly to become accountable care organizations for the Medicare and Medicaid populations because it makes sense if you’re doing it on the commercial side to expand into the Medicare population as well – especially since they now know they won’t have to start all over again.

Q: Have there been many organizations considering becoming ACOs but waiting to see how the court ruled?
A: There are now something close to 260 commercial ACOs already up and running. Where they had been waiting is on the Medicare and Medicaid side but now that the Shared Savings Program will stay intact, those sitting on the sidelines will have that financial incentive not to anymore, so we see them continuing right along. And the quality incentives are really good for patients, so it’s going to be key.

Q: Now, you said its good for patients, is it also good for physicians?
A: It is because you get the incentives aligned with what patients want. Right now, we have reimbursement incentives where it’s based on volume. What we need to do is get more focus around value. So providers will still get reimbursed, they’ll still get compensated much like they have in the past but the incentives will be much more aligned with the patient’s point of view. That’s where we need to go and where we’re getting with ACOs. This law clearly provides incentives for physicians and other providers to become accountable care organizations. The uptake of information technology is huge. Right now, close to 90 percent of our members have already fully implemented electronic health records. From there, you can begin using tools to drive down costs and improve quality.

Q: What are the downsides to the law being upheld?
A: You know I don’t see one, Tom. The provision for Medicaid somewhat in question right now doesn’t hurt providers or patients. In fact, I think if they hadn’t made the exception they made it could harm patients because states could have decided not to participate in the expansion of Medicaid and therefore would have lost the money that they’re presently receiving for their current Medicaid populations and that would hurt patients and the providers who are taking care of them. So I don’t see that part of the ruling as a downside. I think it’s a positive. But there are tweaks to make going forward that will be made in due time.

Q: What would you tweak first?
A: The incentives for individuals to purchase insurance could be tweaked a bit so there’s much more of an incentive for individuals who are healthy and young to participate in the program rather than waiting until they have a diagnosis and then jumping in. And I’d like to see the ACO provision broadened a little bit to drive a little more uptake among providers in terms of the Shared Savings Program.

Q: And of course all this puts Mitt Romney in a tight spot as well with people speculating about whether this will be a victory for Obama or a rallying cry to replace him and repeal the law…
A: It will be interesting to see how that plays out. The court decision isn’t going to change public opinion. That will remain the same irrespective of the court’s ruling. I imagine both parties will play to the pieces of the ruling aligned with their message.
 

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