Mary Ellen Schneider

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, CMS will take 1% of the payments that would otherwise go to hospitals under Medicare’s Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

"This is one of those areas where improvement of quality and reduction in cost go hand-in-hand," Dr. Berwick said. "My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a random sample of discharged patients will be surveyed about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare’s Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register on May 6 and becomes final on July 1.

NEW YORK – Evidence is emerging that treating hyperuricemia and gout could help control comorbid cardiovascular disease, according to Dr. Michael H. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan VA Hospital, New York.

Patients with gout tend to have an average of three to four comorbidities, including hypertension, hyperlipidemia, kidney disease, diabetes, and coronary artery disease. Now there is some limited evidence indicating that lowering uric acid may help to reduce cardiovascular mortality, Dr. Pillinger said at a rheumatology meeting sponsored by New York University.

Data presented at last year’s American College of Rheumatology’s annual meeting show that cardiovascular mortality dropped by nearly half among patients taking urate-lowering therapy. The study, which looked at a database of about 45,000 Taiwanese hyperuricemia patients, also showed that stroke mortality decreased significantly when urate levels were lowered. And the researchers observed a larger decrease in mortality when patients on the drug actually achieved urate lowering than when they did not. "This would suggest that there really is a relationship between uric acid and cardiovascular disease," Dr. Pillinger said.

More research will be needed to know for sure whether lowering uric acid could benefit cardiovascular disease, he said. And other questions remain as well: For example, is it hyperuricemia or gout that conveys the risk for coronary artery disease? That’s unclear, because most of the current studies have been done comparing only hyperuricemia to cardiac outcomes, he said.

Another Taiwanese database study, published last year, compared patients with hyperuricemia and those with gout vs. control patients. After adjusting for comorbidities, the researchers concluded that only gout was a risk for cardiovascular mortality (Rheumatology [Oxford] 2010;49:141-6). But Dr. Pillinger said he’s not convinced that the data should have been adjusted, because if gout or hyperuricemia themselves contribute to the comorbidities, then such an adjustment may lead to an underestimation of the impact of uric acid.

To shed more light on the role of gout and hyperuricemia in cardiovascular disease, researchers at NYU have been recruiting patients to a study assessing coronary artery disease in men with hyperuricemia, in those with gout, and in control patients. Preliminary data from the prospective cohort study indicate that coronary artery disease increases in a stepwise fashion from hyperuricemia to gout, Dr. Pillinger said.

The researchers are also starting to look at how hyperuricemic patients with lower levels of uric acid (6.9-9.0 mg/dL), compared with those who have higher levels (greater than 9.0 mg/dL). In that preliminary subanalysis, patients with the highest levels of uric acid had the highest risk for coronary artery disease and MI. "I think this is beginning to suggest that there’s at least an intermediate risk from having elevated uric acid," Dr. Pillinger said.

Some studies have also shown that treatment of the inflammation associated with gout could help in cardiovascular disease. Researchers performed an analysis of nearly 1,300 patients in the New York VA gout cohort. About half of the patients were on chronic colchicine therapy and half were not taking colchicine. The cross-sectional study, which was presented at the 2010 ACR annual meeting, found that patients who took colchicine had more than a 50% decrease in MI rates, compared with those who were not on the drug. Patients also had a lower risk of death and a lower C-reactive protein level, but these results did not achieve statistical significance. "This is very provocative," Dr. Pillinger said.

Dr. Pillinger said that he had no relevant conflicts of interest to report.

NEW YORK – Evidence is emerging that treating hyperuricemia and gout could help control comorbid cardiovascular disease, according to Dr. Michael H. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan VA Hospital, New York.

Patients with gout tend to have an average of three to four comorbidities, including hypertension, hyperlipidemia, kidney disease, diabetes, and coronary artery disease. Now there is some limited evidence indicating that lowering uric acid may help to reduce cardiovascular mortality, Dr. Pillinger said at a rheumatology meeting sponsored by New York University.

Data presented at last year’s American College of Rheumatology’s annual meeting show that cardiovascular mortality dropped by nearly half among patients taking urate-lowering therapy. The study, which looked at a database of about 45,000 Taiwanese hyperuricemia patients, also showed that stroke mortality decreased significantly when urate levels were lowered. And the researchers observed a larger decrease in mortality when patients on the drug actually achieved urate lowering than when they did not. "This would suggest that there really is a relationship between uric acid and cardiovascular disease," Dr. Pillinger said.

More research will be needed to know for sure whether lowering uric acid could benefit cardiovascular disease, he said. And other questions remain as well: For example, is it hyperuricemia or gout that conveys the risk for coronary artery disease? That’s unclear, because most of the current studies have been done comparing only hyperuricemia to cardiac outcomes, he said.

Another Taiwanese database study, published last year, compared patients with hyperuricemia and those with gout vs. control patients. After adjusting for comorbidities, the researchers concluded that only gout was a risk for cardiovascular mortality (Rheumatology [Oxford] 2010;49:141-6). But Dr. Pillinger said he’s not convinced that the data should have been adjusted, because if gout or hyperuricemia themselves contribute to the comorbidities, then such an adjustment may lead to an underestimation of the impact of uric acid.

To shed more light on the role of gout and hyperuricemia in cardiovascular disease, researchers at NYU have been recruiting patients to a study assessing coronary artery disease in men with hyperuricemia, in those with gout, and in control patients. Preliminary data from the prospective cohort study indicate that coronary artery disease increases in a stepwise fashion from hyperuricemia to gout, Dr. Pillinger said.

The researchers are also starting to look at how hyperuricemic patients with lower levels of uric acid (6.9-9.0 mg/dL), compared with those who have higher levels (greater than 9.0 mg/dL). In that preliminary subanalysis, patients with the highest levels of uric acid had the highest risk for coronary artery disease and MI. "I think this is beginning to suggest that there’s at least an intermediate risk from having elevated uric acid," Dr. Pillinger said.

Some studies have also shown that treatment of the inflammation associated with gout could help in cardiovascular disease. Researchers performed an analysis of nearly 1,300 patients in the New York VA gout cohort. About half of the patients were on chronic colchicine therapy and half were not taking colchicine. The cross-sectional study, which was presented at the 2010 ACR annual meeting, found that patients who took colchicine had more than a 50% decrease in MI rates, compared with those who were not on the drug. Patients also had a lower risk of death and a lower C-reactive protein level, but these results did not achieve statistical significance. "This is very provocative," Dr. Pillinger said.

Dr. Pillinger said that he had no relevant conflicts of interest to report.

NEW YORK – Evidence is emerging that treating hyperuricemia and gout could help control comorbid cardiovascular disease, according to Dr. Michael H. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan VA Hospital, New York.

Patients with gout tend to have an average of three to four comorbidities, including hypertension, hyperlipidemia, kidney disease, diabetes, and coronary artery disease. Now there is some limited evidence indicating that lowering uric acid may help to reduce cardiovascular mortality, Dr. Pillinger said at a rheumatology meeting sponsored by New York University.

Data presented at last year’s American College of Rheumatology’s annual meeting show that cardiovascular mortality dropped by nearly half among patients taking urate-lowering therapy. The study, which looked at a database of about 45,000 Taiwanese hyperuricemia patients, also showed that stroke mortality decreased significantly when urate levels were lowered. And the researchers observed a larger decrease in mortality when patients on the drug actually achieved urate lowering than when they did not. "This would suggest that there really is a relationship between uric acid and cardiovascular disease," Dr. Pillinger said.

More research will be needed to know for sure whether lowering uric acid could benefit cardiovascular disease, he said. And other questions remain as well: For example, is it hyperuricemia or gout that conveys the risk for coronary artery disease? That’s unclear, because most of the current studies have been done comparing only hyperuricemia to cardiac outcomes, he said.

Another Taiwanese database study, published last year, compared patients with hyperuricemia and those with gout vs. control patients. After adjusting for comorbidities, the researchers concluded that only gout was a risk for cardiovascular mortality (Rheumatology [Oxford] 2010;49:141-6). But Dr. Pillinger said he’s not convinced that the data should have been adjusted, because if gout or hyperuricemia themselves contribute to the comorbidities, then such an adjustment may lead to an underestimation of the impact of uric acid.

To shed more light on the role of gout and hyperuricemia in cardiovascular disease, researchers at NYU have been recruiting patients to a study assessing coronary artery disease in men with hyperuricemia, in those with gout, and in control patients. Preliminary data from the prospective cohort study indicate that coronary artery disease increases in a stepwise fashion from hyperuricemia to gout, Dr. Pillinger said.

The researchers are also starting to look at how hyperuricemic patients with lower levels of uric acid (6.9-9.0 mg/dL), compared with those who have higher levels (greater than 9.0 mg/dL). In that preliminary subanalysis, patients with the highest levels of uric acid had the highest risk for coronary artery disease and MI. "I think this is beginning to suggest that there’s at least an intermediate risk from having elevated uric acid," Dr. Pillinger said.

Some studies have also shown that treatment of the inflammation associated with gout could help in cardiovascular disease. Researchers performed an analysis of nearly 1,300 patients in the New York VA gout cohort. About half of the patients were on chronic colchicine therapy and half were not taking colchicine. The cross-sectional study, which was presented at the 2010 ACR annual meeting, found that patients who took colchicine had more than a 50% decrease in MI rates, compared with those who were not on the drug. Patients also had a lower risk of death and a lower C-reactive protein level, but these results did not achieve statistical significance. "This is very provocative," Dr. Pillinger said.

Dr. Pillinger said that he had no relevant conflicts of interest to report.

NEW YORK – Evidence is emerging that treating hyperuricemia and gout could help control comorbid cardiovascular disease, according to Dr. Michael H. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan VA Hospital, New York.

Patients with gout tend to have an average of three to four comorbidities, including hypertension, hyperlipidemia, kidney disease, diabetes, and coronary artery disease. Now there is some limited evidence indicating that lowering uric acid may help to reduce cardiovascular mortality, Dr. Pillinger said at a rheumatology meeting sponsored by New York University.

Data presented at last year’s American College of Rheumatology’s annual meeting show that cardiovascular mortality dropped by nearly half among patients taking urate-lowering therapy. The study, which looked at a database of about 45,000 Taiwanese hyperuricemia patients, also showed that stroke mortality decreased significantly when urate levels were lowered. And the researchers observed a larger decrease in mortality when patients on the drug actually achieved urate lowering than when they did not. "This would suggest that there really is a relationship between uric acid and cardiovascular disease," Dr. Pillinger said.

More research will be needed to know for sure whether lowering uric acid could benefit cardiovascular disease, he said. And other questions remain as well: For example, is it hyperuricemia or gout that conveys the risk for coronary artery disease? That’s unclear, because most of the current studies have been done comparing only hyperuricemia to cardiac outcomes, he said.

Another Taiwanese database study, published last year, compared patients with hyperuricemia and those with gout vs. control patients. After adjusting for comorbidities, the researchers concluded that only gout was a risk for cardiovascular mortality (Rheumatology [Oxford] 2010;49:141-6). But Dr. Pillinger said he’s not convinced that the data should have been adjusted, because if gout or hyperuricemia themselves contribute to the comorbidities, then such an adjustment may lead to an underestimation of the impact of uric acid.

To shed more light on the role of gout and hyperuricemia in cardiovascular disease, researchers at NYU have been recruiting patients to a study assessing coronary artery disease in men with hyperuricemia, in those with gout, and in control patients. Preliminary data from the prospective cohort study indicate that coronary artery disease increases in a stepwise fashion from hyperuricemia to gout, Dr. Pillinger said.

The researchers are also starting to look at how hyperuricemic patients with lower levels of uric acid (6.9-9.0 mg/dL), compared with those who have higher levels (greater than 9.0 mg/dL). In that preliminary subanalysis, patients with the highest levels of uric acid had the highest risk for coronary artery disease and MI. "I think this is beginning to suggest that there’s at least an intermediate risk from having elevated uric acid," Dr. Pillinger said.

Some studies have also shown that treatment of the inflammation associated with gout could help in cardiovascular disease. Researchers performed an analysis of nearly 1,300 patients in the New York VA gout cohort. About half of the patients were on chronic colchicine therapy and half were not taking colchicine. The cross-sectional study, which was presented at the 2010 ACR annual meeting, found that patients who took colchicine had more than a 50% decrease in MI rates, compared with those who were not on the drug. Patients also had a lower risk of death and a lower C-reactive protein level, but these results did not achieve statistical significance. "This is very provocative," Dr. Pillinger said.

Dr. Pillinger said that he had no relevant conflicts of interest to report.

NEW YORK – Evidence is emerging that treating hyperuricemia and gout could help control comorbid cardiovascular disease, according to Dr. Michael H. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan VA Hospital, New York.

Patients with gout tend to have an average of three to four comorbidities, including hypertension, hyperlipidemia, kidney disease, diabetes, and coronary artery disease. Now there is some limited evidence indicating that lowering uric acid may help to reduce cardiovascular mortality, Dr. Pillinger said at a rheumatology meeting sponsored by New York University.

Data presented at last year’s American College of Rheumatology’s annual meeting show that cardiovascular mortality dropped by nearly half among patients taking urate-lowering therapy. The study, which looked at a database of about 45,000 Taiwanese hyperuricemia patients, also showed that stroke mortality decreased significantly when urate levels were lowered. And the researchers observed a larger decrease in mortality when patients on the drug actually achieved urate lowering than when they did not. "This would suggest that there really is a relationship between uric acid and cardiovascular disease," Dr. Pillinger said.

More research will be needed to know for sure whether lowering uric acid could benefit cardiovascular disease, he said. And other questions remain as well: For example, is it hyperuricemia or gout that conveys the risk for coronary artery disease? That’s unclear, because most of the current studies have been done comparing only hyperuricemia to cardiac outcomes, he said.

Another Taiwanese database study, published last year, compared patients with hyperuricemia and those with gout vs. control patients. After adjusting for comorbidities, the researchers concluded that only gout was a risk for cardiovascular mortality (Rheumatology [Oxford] 2010;49:141-6). But Dr. Pillinger said he’s not convinced that the data should have been adjusted, because if gout or hyperuricemia themselves contribute to the comorbidities, then such an adjustment may lead to an underestimation of the impact of uric acid.

To shed more light on the role of gout and hyperuricemia in cardiovascular disease, researchers at NYU have been recruiting patients to a study assessing coronary artery disease in men with hyperuricemia, in those with gout, and in control patients. Preliminary data from the prospective cohort study indicate that coronary artery disease increases in a stepwise fashion from hyperuricemia to gout, Dr. Pillinger said.

The researchers are also starting to look at how hyperuricemic patients with lower levels of uric acid (6.9-9.0 mg/dL), compared with those who have higher levels (greater than 9.0 mg/dL). In that preliminary subanalysis, patients with the highest levels of uric acid had the highest risk for coronary artery disease and MI. "I think this is beginning to suggest that there’s at least an intermediate risk from having elevated uric acid," Dr. Pillinger said.

Some studies have also shown that treatment of the inflammation associated with gout could help in cardiovascular disease. Researchers performed an analysis of nearly 1,300 patients in the New York VA gout cohort. About half of the patients were on chronic colchicine therapy and half were not taking colchicine. The cross-sectional study, which was presented at the 2010 ACR annual meeting, found that patients who took colchicine had more than a 50% decrease in MI rates, compared with those who were not on the drug. Patients also had a lower risk of death and a lower C-reactive protein level, but these results did not achieve statistical significance. "This is very provocative," Dr. Pillinger said.

Dr. Pillinger said that he had no relevant conflicts of interest to report.

NEW YORK – Evidence is emerging that treating hyperuricemia and gout could help control comorbid cardiovascular disease, according to Dr. Michael H. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan VA Hospital, New York.

Patients with gout tend to have an average of three to four comorbidities, including hypertension, hyperlipidemia, kidney disease, diabetes, and coronary artery disease. Now there is some limited evidence indicating that lowering uric acid may help to reduce cardiovascular mortality, Dr. Pillinger said at a rheumatology meeting sponsored by New York University.

Data presented at last year’s American College of Rheumatology’s annual meeting show that cardiovascular mortality dropped by nearly half among patients taking urate-lowering therapy. The study, which looked at a database of about 45,000 Taiwanese hyperuricemia patients, also showed that stroke mortality decreased significantly when urate levels were lowered. And the researchers observed a larger decrease in mortality when patients on the drug actually achieved urate lowering than when they did not. "This would suggest that there really is a relationship between uric acid and cardiovascular disease," Dr. Pillinger said.

More research will be needed to know for sure whether lowering uric acid could benefit cardiovascular disease, he said. And other questions remain as well: For example, is it hyperuricemia or gout that conveys the risk for coronary artery disease? That’s unclear, because most of the current studies have been done comparing only hyperuricemia to cardiac outcomes, he said.

Another Taiwanese database study, published last year, compared patients with hyperuricemia and those with gout vs. control patients. After adjusting for comorbidities, the researchers concluded that only gout was a risk for cardiovascular mortality (Rheumatology [Oxford] 2010;49:141-6). But Dr. Pillinger said he’s not convinced that the data should have been adjusted, because if gout or hyperuricemia themselves contribute to the comorbidities, then such an adjustment may lead to an underestimation of the impact of uric acid.

To shed more light on the role of gout and hyperuricemia in cardiovascular disease, researchers at NYU have been recruiting patients to a study assessing coronary artery disease in men with hyperuricemia, in those with gout, and in control patients. Preliminary data from the prospective cohort study indicate that coronary artery disease increases in a stepwise fashion from hyperuricemia to gout, Dr. Pillinger said.

The researchers are also starting to look at how hyperuricemic patients with lower levels of uric acid (6.9-9.0 mg/dL), compared with those who have higher levels (greater than 9.0 mg/dL). In that preliminary subanalysis, patients with the highest levels of uric acid had the highest risk for coronary artery disease and MI. "I think this is beginning to suggest that there’s at least an intermediate risk from having elevated uric acid," Dr. Pillinger said.

Some studies have also shown that treatment of the inflammation associated with gout could help in cardiovascular disease. Researchers performed an analysis of nearly 1,300 patients in the New York VA gout cohort. About half of the patients were on chronic colchicine therapy and half were not taking colchicine. The cross-sectional study, which was presented at the 2010 ACR annual meeting, found that patients who took colchicine had more than a 50% decrease in MI rates, compared with those who were not on the drug. Patients also had a lower risk of death and a lower C-reactive protein level, but these results did not achieve statistical significance. "This is very provocative," Dr. Pillinger said.

Dr. Pillinger said that he had no relevant conflicts of interest to report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners' physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it's nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians' groups see pluses and minuses in the government's vision for ACOs.

Officials at the American Medical Association have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs.

Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs.

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You've got a $2.7 trillion stream going in the wrong direction," he said. "That's a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it's really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down.

At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can't access their laboratory data online, they'll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we've done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners' physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it's nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians' groups see pluses and minuses in the government's vision for ACOs.

Officials at the American Medical Association have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs.

Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs.

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You've got a $2.7 trillion stream going in the wrong direction," he said. "That's a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it's really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down.

At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can't access their laboratory data online, they'll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we've done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners' physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it's nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians' groups see pluses and minuses in the government's vision for ACOs.

Officials at the American Medical Association have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs.

Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs.

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You've got a $2.7 trillion stream going in the wrong direction," he said. "That's a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it's really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down.

At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can't access their laboratory data online, they'll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we've done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

Many physicians in private practice are asking themselves if they should go the way of an ACO, and the prediction is that eventually, “Everybody will be somehow be involved with these ACOs,” according to Dr. Rowan Zetterman, an internist and gastroenterologist at Creighton University in Omaha, Neb. With the help of UniNet, a physician hospital organization, Creighton is joining forces with Alegent Hospital to form an ACO that will organize 700 private practitioners, including 120 primary care providers.

There are “very good data” to show that ACOs are highly effective and improve quality of care, Dr. Zetterman noted. “But will they will lower costs? I don’t know.”

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. 

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault, Frances Correa, and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

Many physicians in private practice are asking themselves if they should go the way of an ACO, and the prediction is that eventually, “Everybody will be somehow be involved with these ACOs,” according to Dr. Rowan Zetterman, an internist and gastroenterologist at Creighton University in Omaha, Neb. With the help of UniNet, a physician hospital organization, Creighton is joining forces with Alegent Hospital to form an ACO that will organize 700 private practitioners, including 120 primary care providers.

There are “very good data” to show that ACOs are highly effective and improve quality of care, Dr. Zetterman noted. “But will they will lower costs? I don’t know.”

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. 

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault, Frances Correa, and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

Many physicians in private practice are asking themselves if they should go the way of an ACO, and the prediction is that eventually, “Everybody will be somehow be involved with these ACOs,” according to Dr. Rowan Zetterman, an internist and gastroenterologist at Creighton University in Omaha, Neb. With the help of UniNet, a physician hospital organization, Creighton is joining forces with Alegent Hospital to form an ACO that will organize 700 private practitioners, including 120 primary care providers.

There are “very good data” to show that ACOs are highly effective and improve quality of care, Dr. Zetterman noted. “But will they will lower costs? I don’t know.”

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. 

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault, Frances Correa, and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. (Click here to view a video interview with Dr. Blum).

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. (Click here to view a video interview with Dr. Blum).

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. (Click here to view a video interview with Dr. Blum).

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. (Click here to view a video interview with Dr. Blum).

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. (Click here to view a video interview with Dr. Blum).

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault and Naseem Miller contributed to this report.

The medical model of "the more you do, the more you make" is out, according to Dr. William Chin, and so is the idea that the physician needs to do everything personally. If a service can be provided more efficiently by a nurse or social worker, that may be the way to go under the next big thing in health care – the accountable care organization.

Dr. Chin, executive medical director for HealthCare Partners, an independent physician association (IPA) based in Torrance, Calif., said his group plans to participate in the new Medicare shared savings program for ACOs, which will launch in January. The group has been preparing for the transition for a while: They are currently also working with Anthem Blue Cross in California to test how an ACO would work in the commercial market as well as testing ACO accreditation standards being developed by the National Committee for Quality Assurance (NCQA).

HealthCare Partners’ physicians in California have been working in the global capitation market for many years and Dr. Chin said this experience will help them transition to being an ACO.

"We have had the experience of improving outcomes and reducing costs, improving patient satisfaction, improving the patient experience in our model," Dr. Chin said. "Some of the common goals of the ACO are things that we are doing today."

This year is likely to be a "learning year" for their practices, Dr. Chin said, as they prepare to meet the various standards being developed for ACOs. One advantage they will have is that their practices have already adopted electronic health records. Without that investment in technology, it’s nearly impossible to become efficient and improve quality because paper charts are intractable to analysis, according to Dr. Chin.

But even with EHRs in place, all practices seeking to become ACOs will have to deal with significant culture changes and shifts in the delivery model, he said.

ACOs have been a hot topic in health care circles since they were written into the Affordable Care Act. The law includes the shared savings program through Medicare, which will allow ACOs to earn additional payments if they can both save the government money and meet quality benchmarks. As the program goes forward, physicians also would assume some financial risk if they are unable to provide cost-effective care.

Officials at the Centers for Medicare and Medicaid Services released a proposed regulation on Mar. 31 outlining how the Medicare ACO program will work. Under the new voluntary program, ACOs could include physicians in group practices, networks of individual practices, hospitals that employ physicians, and partnerships between these entities, as well as other providers. An ACO will be a partnership among both primary care and specialist physicians; however, only primary care providers will be able to form an ACO, according to the proposed regulation.

Providers working in an ACO would continue to receive regular payments under Medicare fee for service, but could qualify for additional payments if they save money for the program. The proposed regulation requires that ACOs meet quality standards and demonstrate that they have reduced costs in order to be eligible to share in savings. The proposal outlines 65 quality measures in five domains: patient experience, care coordination, patient safety, preventive health, and metrics for the care of at-risk and frail elderly populations.

The proposed regulation also creates two models for how an ACO can share in the potential Medicare savings, depending on its level of maturity. Under a one-sided risk model, a less-developed ACO can share in the savings they produce during the first 2 years and then assume financial risk in year 3, sharing in any potential financial losses.

More mature organizations can pursue the two-sided risk model and share in the potential savings and losses immediately. As an incentive to assume risk earlier, ACOs that pursue the two-side risk model will be eligible for a shared savings percentage of 60%, as compared with 50% for those in the one-side risk model.

Physicians’ groups see pluses and minuses in the government’s vision for ACOs.

The proposed regulation has some good points, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians, but doesn’t provide much incentive for small- and medium-size practices to participate. For example, the program focuses on too many quality measures in the first year and the number of covered beneficiaries that must be in an ACO might be too high for many smaller practices to reach. Also, the design for one-sided and two-sided risk is likely too complex to attract practices without experience operating as an ACO, he said.

Dr. Goertz said the AAFP will file public comments on the proposed regulation urging changes to make it more attractive to smaller practices. In the meantime, he advised family physicians not to rush into any ACO deals. Family physicians are in a good bargaining position and should try to avoid making commitments to other organizations before they have a clear sense of the final regulation from the CMS.

When it comes time to make those agreements, physicians must be clear on the details of risk sharing and payments to individual physicians. "Don’t undervalue yourself in terms of the potential of the ACO," he advised.

Officials at the American Medical Association also have voiced some concerns about the investments that physicians, especially those in small practices, would need to make in order to become part of an ACO. Potential investment might include an electronic health record, hiring nurse care managers to assist in patient education and self-support, or adding currently unreimbursed services such as e-mail communication with patients and other physicians.

The AMA has recommended that the CMS create loan- and technical-assistance programs to help small physician practices in becoming ACOs. Since commercial lenders might be reluctant to grant lines of credit, given the uncertainty and confusion that surround health care payments, the AMA suggested that the CMS educate lenders on the new revenue streams associated with ACOs. CMS also could create a loan guarantee program to make it easier for small physician practices and IPAs to get financing from commercial lenders. Or, the AMA suggested, the CMS could make grants to nonprofit commercial organizations that could provide grants, loans, and technical assistance.

One area in which physicians may need to make investments is in health information technology. Jonathan Blum, director of the Center for Medicare Management, said the ACO proposal is closely aligned with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the electronic health record incentive programs. Coordinating the ACO quality measures with those in the EHR incentive programs reduces the burden on physicians and hospitals that are submitting data through the various programs, Mr. Blum said. It also offers the potential for physicians to offset some of their technology costs through the bonus payments they can earn by achieving meaningful use of their EHRs. (Click here to view a video interview with Dr. Blum).

The move to ACOs will be a major shift, said Dr. Paul Grundy, director of health care transformation for IBM and president of the Patient-Centered Primary Care Collaborative. "You’ve got a $2.7 trillion stream going in the wrong direction," he said. "That’s a huge river to overcome."

But despite the financial and cultural barriers that have prevented these types of shifts from occurring in the past, Dr. Grundy said the medical community is ready to make a change toward the patient-centered medical home concept and ACOs.

Many purchasers of health care, including Fortune 100 companies and the federal government, are already supporting the concept of the medical home and physicians who have made the switch love it, he said. "I think it’s really clear that this is where we’re going and where we have to go."

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. "For them to be told by a practice that they can’t access their laboratory data online, they’ll just keep looking until they find someone who can," Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a "road map" for organizations to begin to build the capabilities to become an ACO, she said. "What we’ve done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about."

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO.

"We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient centered care in forming these organizations," she said.

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault and Naseem Miller contributed to this report.

Starting April 18, physicians can begin sending data to the federal government to qualify for thousands of dollars in bonus payments under the new Medicare electronic health record incentive program.

The program officially began on Jan. 3, but this is the first day that physicians and other eligible providers can submit data on their "meaningful use" of electronic health records (EHRs). In order to qualify for Medicare incentive payments for 2011, physicians must report on at least 90 days of meaningful use occurring during this calendar year. Oct. 1, 2011, is the last day that physician can begin their 90-day reporting period to receive a 2011 incentive payment. The first checks for the Medicare incentive program are expected to go out in May, according to the Centers for Medicare and Medicaid Services.

The incentive program, which was authorized under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, offers payments to physicians who use health information technology to improve patient care. Federal regulations governing the program spell out how physicians and hospitals can meet standards for the meaningful use of certified EHR technology. Physicians that meet the criteria are eligible to receive up to $44,000 over five years under the Medicare program. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must qualify for the program before the end of 2012 to get all the available incentives.

A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHR technology.

As part of the attestation process, physicians and other eligible providers must go online to report data on a number of meaningful use and quality measures established by CMS. Through the online portal, physicians can report the numerator, denominator, and any potential exclusions for the objectives.

They can also attest that they have successfully met the program requirements. For example, the meaningful use regulations require that providers maintain an up-to-date accounting of current and active diagnoses. To be eligible for incentives, providers must report that more than 80% of all unique patients seen by the provider have at least one entry, or an indicator that no problems are known for the patients. The data must be recorded in a structured format.

"There is a great deal of interest in the meaningful use program," said William Underwood, a senior associate in the division of medical practice, professionalism, and quality at the American College of Physicians.

But while interest is high, that doesn’t mean physicians will be clamoring to report on meaningful use immediately. Right now, physicians in both small and large practices are struggling with logistical hurdles, Mr. Underwood said.

For example, there is currently not a process in place to allow practice administrators to submit meaningful use data to CMS on behalf of large physician practices. The current set-up requires a physician to report the information. While CMS officials plan to address this, it hasn’t happened yet, Mr. Underwood said.

Some small practices are having difficulty meeting meaningful use thresholds because other entities aren’t exchanging information with them regarding labs and referrals. And practices of all sizes are waiting for vendors to finish rolling out updates that show they’re in compliance with meaningful use certification, he said.

Starting April 18, physicians can begin sending data to the federal government to qualify for thousands of dollars in bonus payments under the new Medicare electronic health record incentive program.

The program officially began on Jan. 3, but this is the first day that physicians and other eligible providers can submit data on their "meaningful use" of electronic health records (EHRs). In order to qualify for Medicare incentive payments for 2011, physicians must report on at least 90 days of meaningful use occurring during this calendar year. Oct. 1, 2011, is the last day that physician can begin their 90-day reporting period to receive a 2011 incentive payment. The first checks for the Medicare incentive program are expected to go out in May, according to the Centers for Medicare and Medicaid Services.

The incentive program, which was authorized under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, offers payments to physicians who use health information technology to improve patient care. Federal regulations governing the program spell out how physicians and hospitals can meet standards for the meaningful use of certified EHR technology. Physicians that meet the criteria are eligible to receive up to $44,000 over five years under the Medicare program. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must qualify for the program before the end of 2012 to get all the available incentives.

A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHR technology.

As part of the attestation process, physicians and other eligible providers must go online to report data on a number of meaningful use and quality measures established by CMS. Through the online portal, physicians can report the numerator, denominator, and any potential exclusions for the objectives.

They can also attest that they have successfully met the program requirements. For example, the meaningful use regulations require that providers maintain an up-to-date accounting of current and active diagnoses. To be eligible for incentives, providers must report that more than 80% of all unique patients seen by the provider have at least one entry, or an indicator that no problems are known for the patients. The data must be recorded in a structured format.

"There is a great deal of interest in the meaningful use program," said William Underwood, a senior associate in the division of medical practice, professionalism, and quality at the American College of Physicians.

But while interest is high, that doesn’t mean physicians will be clamoring to report on meaningful use immediately. Right now, physicians in both small and large practices are struggling with logistical hurdles, Mr. Underwood said.

For example, there is currently not a process in place to allow practice administrators to submit meaningful use data to CMS on behalf of large physician practices. The current set-up requires a physician to report the information. While CMS officials plan to address this, it hasn’t happened yet, Mr. Underwood said.

Some small practices are having difficulty meeting meaningful use thresholds because other entities aren’t exchanging information with them regarding labs and referrals. And practices of all sizes are waiting for vendors to finish rolling out updates that show they’re in compliance with meaningful use certification, he said.

Starting April 18, physicians can begin sending data to the federal government to qualify for thousands of dollars in bonus payments under the new Medicare electronic health record incentive program.

The program officially began on Jan. 3, but this is the first day that physicians and other eligible providers can submit data on their "meaningful use" of electronic health records (EHRs). In order to qualify for Medicare incentive payments for 2011, physicians must report on at least 90 days of meaningful use occurring during this calendar year. Oct. 1, 2011, is the last day that physician can begin their 90-day reporting period to receive a 2011 incentive payment. The first checks for the Medicare incentive program are expected to go out in May, according to the Centers for Medicare and Medicaid Services.

The incentive program, which was authorized under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, offers payments to physicians who use health information technology to improve patient care. Federal regulations governing the program spell out how physicians and hospitals can meet standards for the meaningful use of certified EHR technology. Physicians that meet the criteria are eligible to receive up to $44,000 over five years under the Medicare program. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must qualify for the program before the end of 2012 to get all the available incentives.

A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHR technology.

As part of the attestation process, physicians and other eligible providers must go online to report data on a number of meaningful use and quality measures established by CMS. Through the online portal, physicians can report the numerator, denominator, and any potential exclusions for the objectives.

They can also attest that they have successfully met the program requirements. For example, the meaningful use regulations require that providers maintain an up-to-date accounting of current and active diagnoses. To be eligible for incentives, providers must report that more than 80% of all unique patients seen by the provider have at least one entry, or an indicator that no problems are known for the patients. The data must be recorded in a structured format.

"There is a great deal of interest in the meaningful use program," said William Underwood, a senior associate in the division of medical practice, professionalism, and quality at the American College of Physicians.

But while interest is high, that doesn’t mean physicians will be clamoring to report on meaningful use immediately. Right now, physicians in both small and large practices are struggling with logistical hurdles, Mr. Underwood said.

For example, there is currently not a process in place to allow practice administrators to submit meaningful use data to CMS on behalf of large physician practices. The current set-up requires a physician to report the information. While CMS officials plan to address this, it hasn’t happened yet, Mr. Underwood said.

Some small practices are having difficulty meeting meaningful use thresholds because other entities aren’t exchanging information with them regarding labs and referrals. And practices of all sizes are waiting for vendors to finish rolling out updates that show they’re in compliance with meaningful use certification, he said.