Otolaryngologists Prepare for the Era of Accountable Care Organizations (ACOs)

After a few rough patches, public and private efforts to establish accountable care organizations (ACOs) are gaining speed.

Since 2011, the Centers for Medicare and Medicaid Services (CMS) has initiated or expanded several demonstration projects aimed at improving patient outcomes and containing costs by encouraging provider groups to assume shared responsibility for a defined pool of patients. Prominent medical organizations panned an initial draft of a CMS project called the Shared Savings Program, but the agency won over most critics with a well-received final version of the rules that provided more incentives for groups to form their own accountable care organizations. Last fall’s presidential election provided further clarity about the future of health care reform, and medical groups around the country are now readily jumping on the ACO bandwagon.

Few medical groups have enough data to suggest whether their varied approaches to managing patient populations will lead to better quality care that’s also more affordable, and even the precise definition of an ACO remains a moving target. But industry analysts say they’re surprised and encouraged by the speed with which the movement has taken flight, the breadth of models being investigated, the strong engagement of the private sector and a spreading sense of cautious optimism.

So far, few otolaryngologists have had direct experience with ACOs, many of which are initially focusing on specific, high-risk patient populations and haven’t yet developed performance standards relevant to otolaryngology. As the health care delivery model evolves, expands and better defines the role of specialists, though, several observers say they expect an increasingly broad swath of providers to be added to the mix. And with the model’s maturation, they say, otolaryngologists may play an active role in shaping the future of accountable care.

Getting Up to Speed

Now is the time to engage, said Michael Coppola, MD, associate clinical professor of medicine at Tufts University School of Medicine in Boston and chief medical officer at NovaSom, Inc., a Glen Burnie, Maryland-based company that develops home testing and evaluation for obstructive sleep apnea. “I think that all specialists—and ear, nose and throat surgeons are clearly part of that—need to understand what is valued in the future versus what was valued in the past, and position themselves in an opportunity to add value and to be recognized for that,” he said.

Whereas the fee-for-service system valued intensity of service, future rewards may hinge on a combination of efficiency and quality improvement. “So people are going to be more focused not on, ‘What did you do?’ but on, ‘What happened to the patient as a result of that? What was the outcome?’” Dr. Coppola said. More broadly, he added, ACOs will increasingly ask such questions about the health outcomes of populations, not just about the fate of specific patients.