Document Type

Article

Publication Date

11-1-2011

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in PM and R

Volume 3, Issue 11, November 2011, Pages 1068-1071.

The published version is available at DOI: 10.1016/j.pmrj.2011.09.009. Copyright © Elsevier Inc.

Abstract

The goal of delivering quality health care at a lower overall cost through accountable care organizations (ACO) as described as part of the Patient Protection and Affordable Care Act of 2010 (ACA) has gained momentum among payers, providers, and the public. The concept includes developing an organization that provides incentives for quality care while lowering the overall cost of the care. If the goals are met, then both providers and payers would be able to share in the financial savings produced by the lower health care costs achieved while improving the quality of care delivered. The Centers for Medicare and Medicaid Services (CMS) has further defined ACOs in the proposal rule released March 31, 2011, in the Medicare Shared Savings Program: Accountable Care Organizations. Medicare has projected that, over the first 3 years, there will be 75-150 ACOs developed, resulting in coverage of 1.5-4.0 million Medicare beneficiaries. This initial phase has been projected to save Medicare $510-$800 million in health care costs [1,2]. Regardless of whether or not this initial model of ACOs will have long-term validity, it is likely that components of the model will be included in future health care reform; therefore, physical medicine and rehabilitation (PM&R) providers will have to decide how they will respond to these future changes. This article describes some of the CMS proposed ACO regulations and strategies that practices might consider to prepare for the future.

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