Accountable Care Organizations

[Guest guest]

*Accountable Care Organizations*

I had the wonderful opportunity to participate again this year in the

APTA/Private

Practice Section <http://www.PPSAPTA.org> " Think Tank " called The Graham

Sessions. This year they were held in Austin, TX mid January.

Over the years, the format of these sessions has changed a bit but the high

quality of participants and excellent interaction has remain constant.

One of the sessions this year was on Accountable Care Organizations

(ACO)<http://pnhpcalifornia.org/2010/10/the-history-and-definition-of-the-%E2%80\

%9Caccountable-care-organization%E2%80%9D/>and

the role that PT might have should they come into existence as

mandated

in The Affordable Care Act of 2010 (ACA)

<http://www.healthcare.gov/law/introduction/index.html>[Health Care Reform

(HCR)].

This is a fascinating, albeit theoretical, discussion for all of us as PTs.

Since there are few, if any, models for ACOs already in place, speculation

about a variety of models provides for good discussion.

There are several things that are very likely in any ACO model: there will

be (as yet undefined) financial relationships between all the providers

involved, physician leadership will be critical, cost savings will be

shared and outcomes will be critical to measure, However, as one of the

participants at the Graham Sessions noted: " If you have seen one ACO, you

have seen just one ACO " . Many models are likely with a variety of styles

and structures and cultures.

One of the key conclusions that I came to, and I think most of the

participants joined me, was that the relationship of the PT practice to the

ACO is paramount. Issues to address included financial incentives, payment

structures, risk sharing and measurement of outcomes. This may present an

opportunity for PTs to get very creative, develop strong working

relationships with key decision makers and policy shapers and really show

what wonderful skills and results we can provide.

Most critical will be our ability to " get to the table " to discuss our role

and abilities and highlight the advantages high quality PT can have in an

ACO system. If we fail to get to the table during these discussions, we

will, once again, be running from behind and may very well never catch up to

the players at the " grown-up table " .

This is a time for big thinking and big thinkers. " Outcomes " as we

traditionally think of them in PT may significantly change. Although I am

confident that rehabilitation and functional recovery will always be

perceived as " Valuable " by right thinking individuals, in an ACO model, our

greatest value may come from our ability to help our patients avoid the

big-ticket items of surgery, excessive imaging and lifelong medication

costs. Like I said - big thinkers will be needed at that table when these

sorts of decisions are being made.

I am not completely sure what will happen with ACO or even HCR in the coming

months. I do know that we better be ready to be at that table.

Here is a link - http://bit.ly/hohpDu - to a Feb 3, 2001 post on ACO's and

AntiTrust <http://bit.ly/hohpDu> by Merrill Goozner that raises some

interesting questions of antiTrust and monopolistic behavior for ACOs and

some that may matter to PTs.

As always, your comments, input and feedback are always welcome.

R. Kovacek, PT, DPT, MSA