Accountable Care Organizations
Governmental payers, the employer community and commercial health insurance companies are all pushing for more integrated health care delivery systems where physicians and hospitals are held accountable for the overall cost and quality of care. Regardless of the Medicare Accountable Care Organization (ACO) program’s success, it is likely that all physicians will need to participate in systems requiring more communication, care coordination and quality measurement reporting.
This document provides a detailed overview of the various options physicians have in this changing environment, including the benefits and challenges associated with establishing or participating in physician and other health care provider collaboratives.
- Preface, contributors, table of contents and legal disclaimer
This section provides an overview of the manual and its contributors, as well as the legal disclaimer that the publication does not contain legal advice. Preface/Contributors/Table of Contents
- Introduction: Complex environment—difficult choices
This section gives context for the challenges faced by today’s physician practices. Contributor: David W. Hilgers, partner, Brown McCarroll, LLP and former chair, American Bar Association Health Law Section.
- Chapter One: Accountable care organizations—overview
This chapter provides a history and definition of ACOs and reviews the benefits and challenges that physicians should consider prior to participation. Contributor: Sidney S. Welch, partner, Arnall Golden Gregory, LLP.
- Chapter Two: Accountable care organization governance issues
ACOs require a governing body and bylaws to manage physicians’ and other participants’ interaction and revenue allocation. This chapter reviews the key concepts of ACO governance and provides strategies to ensure that the rules established serve the best interest of participating physicians. Contributor: Stephen M. Fatum, partner, Barnes & Thornburg, LLP, and Robert M. Martin, president, Breakthrough Physician Solutions LLC.
- Chapter Three: Partnering with hospitals to create an accountable care organization
This chapter focuses on establishing a physician-hospital ACO partnership and suggests an approach that physicians may take to develop a relationship that is beneficial to all parties. Contributor: Elias Matsakis, partner, Holland & Knight, LLP.
- Chapter Four: Partnering with health insurers to create an accountable care organization
This chapter provides an overview of the potential benefits and challenges of establishing a physician-health insurer ACO relationship. Contributor: Wes Cleveland, senior attorney, Private Sector Advocacy, American Medical Association.
- Chapter Five: Guidance on earning electronic health records incentive payments
Health reform includes federal incentives for physicians who adopt electronic health record (EHR) systems. This chapter provides an overview of this issue and strategies for physicians interested in acquiring EHR technology. Contributor: Larry M. Zanger, partner, Holland & Knight, LLP.
- Chapter Six: Managing antitrust risk associated with accountable care organizations
While the formation of ACOs is encouraged by the federal government, these organizations are required to comply with antitrust laws. This chapter provides an overview of antitrust laws, their enforcement and how they apply to ACOs. Contributors: Henry S. Allen Jr., senior attorney, Private Sector Advocacy, American Medical Association. and George M. Sanders, solo practitioner, Law Offices of George M. Sanders, P.C.
- Chapter Seven: Hospital physician employment agreements
Hospitals are increasing efforts to employ physicians. This chapter discusses key issues physicians should consider prior to entering into an employment agreement. Contributors: Wilson Hayman and Steven Mansfield Shaber, partners, PoynerSpruill, and Kimberly Licata, attorney, PoynerSpruill.
- Chapter Eight: Retaining independence while embracing accountability: Care coordination and integration strategies for small physician practices
This chapter provides detailed guidance describing how solo practicioners and physicians practicing in small groups can acquire the core capabilities necessary to succeed in new payment and delivery models, and the steps that physicians can readily take to improve health care quality, inluding how to standardize their practices, improve care coordination, and utilize their practice data. Contributor: Astrid G. Meghrigian, JD.
Consider the AMA your ally and advocate in issues related to ACOs, CO-OPs and other collaboratives. Find archived letters and other documentation related to our advocacy efforts on this topic. AMA policy, as well as official federal guidance related to this advocacy effort, is also provided.