ACO – A Year in Review

A wrap-up of Accountable Care Organizations discussion in 2011, and a peek into where it’s going in 2012

As 2011 winds to a close, I feel almost breathless looking back at all that has happened in healthcare payment reform! This is a good time to look back, reflect and strategize as we prepare for 2012.

This spring, preliminary regulations on Accountable Care Organizations were published and roundly criticized by healthcare providers as placing too much risk on providers, being onerous in IT requirements and downright backwards in patient assignment. These and other concerns were addressed, and the final regulations were published by fall. Importantly, patient assignment concerns were addressed as well as financial risk for physicians. But despite these changes much angst remains. Contacts are set to be offered in the spring and summer of 2012 and, to date, there has not been a flood of takers.

Patients seem to be almost ignored “passengers” in this process even though the program is “voluntary”….for now. As physicians, we are ethically bound to “do no harm,” our population of patients is at disproportional risk. Although acknowledged by CMS, and supported by data from the ESRD disease demonstration project, we had little success is convincing CMS to allow the ESRD population be considered a stand-alone ACO.

Enter 2012. The Center for Medicare and Medicaid Innovation (CMMI) has been in continual communication with the RPA, ASN and dialysis organizations (large and small), and is considering allowing a “renal integrated care program.” This program will allow nephrologists and dialysis providers to expand on the lessons learned in the ESRD demonstration project to a broader patient base, hopefully as the first step in allowing our population, with their unique needs, to stand-alone in a future payment model. The integrated care program would work with local hospital and healthcare systems placing nephrologists in clinical lead positions to render care being sensitive to the reality that “one size fits all” often doesn’t apply to medicine.

This is a great opportunity for all nephrologists to lead with what we have learned over the past 30 years from the ESRD program.

I suggest you stay involved or get involved! This is your future, your patients’ future and can still be shaped by you! Contact CMMI ( – let your views be heard!

As always, let me know your thoughts!

Merry Christmas and Happy Hanukkah
Robert Provenzano, MD

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ACO – A Year in Review
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2 Responses to ACO – A Year in Review

  1. wilson parry md says:

    My thought about ACO’s and pay for performance: The best patients will be “Cherry Picked,” the older population and those severely ill will less likely be offered dialysis, and those of us who can, will stop practicing or adjust their practice so as to limit medicare or medicaid exposure. We looked into forming an ACO..but it is not for our group..I have stopped trying to even keep up with the changing ACO req.: We are simply growing our group as large as we can: hopefully we will be too big to fail..Just like the automotive industry..the banking industry etc…The more you can control a region, the better the politics treat you because I am sure some day we will be forced to sell out…My opinion isle are taking many steps in the wrong direction..There are many better means of reform than what are being offered..

    • Robert Provenzano, MD says:

      I think you are right to have healthy skepticism. ACOs are a work in progress and much needs to be done before they solve any existing problems; and hopefully not create others!

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