Primary Care Physicians REALLY need to pay attention to the proposed ACO rules

The Centers for Medicare and Medicaid Services (CMS) recently issued the proposed rules for Accountable Care Organizations (ACOs).  The proposed rules are very much in lockstep with the transformation of the healthcare delivery system around the concepts of PCMH.

The proposed rules provide a "shared savings" payment methodology on top of traditional fee for service for Medicare beneficiaries.  The ACO's that share in the saving will ultimately also be required to share in the risk.

There are a number of issues in the proposed rules that are very important and indeed potentially favorable for primary care:

1. Patients in an ACO will be attributed according to the primary care physician they see.
2. A primary care physician can only belong to one ACO for Medicare patients.
3. Hospitals, physician groups, or IPAs can all form ACOs.
4. The quality metrics required for an ACO to share in savings are very much in line with PCMH attributes and accepted standards of car.e
5. 50% of the practices in an ACO must meet meaningful use criteria, thus requiring a 50% or greater utilization of EMRs.
6. The ability to capture and share meaningful data will be critical.
7. An ACO can only sign up in January of each year beginning in January 2012.

The proposed rules recognize the value (cost/quality) of primary care and also the value of the concepts of the Patient-Centered Medical Home.  Given the fact that patients in ACOs are going to be assigned based on the patient's primary care provider, primary care physicians with a strong record on quality and cost control are going to be in great demand.  It will be very important that primary care physicians appreciate their own value. 

Most feel that things in the ACO space are going to move very quickly.  Certainly the activity in the hospital world has been dramatic since the CMS announcement of the proposed rules. 

The challenge is that practicing primary care physicians must not abdicate their responsibility and involvement in this development to hospitals and large systems.

Primary Care physicians in practice must read and learn as much as they can, stay very attuned to which entities might be developing ACOs in their market and start positioning themselves now by moving quickly — transforming their practices, embracing EMRs and meaningful use while paying close attention to their "value" proposition.

As I have said many times before, ACO payment methodologies can be a very good or very bad thing for primary care.  The proposed rules set the stage for it to be very good for primary care, but now it is up to primary care!