The story line on 2011 is simple: It’s healthcare reform and the continuing call for providers to hold the line on healthcare costs while improving quality. This week on Repertoire’s blog we’ll take a look at some of the leading stories of 2011 based off of the December issue’s cover story. For the full story and issue visit


Accountable care organizations


The acronym “ACO” was red hot in 2011. Some of the ardor was cooled, though, after the Centers for Medicare & Medicaid Services published a 126-page notice of proposed rules for accountable care organizations on March 31, 2011. Many in the industry were dismayed by the high costs and complexity associated with setting up and operating an ACO. Accountable care organizations would allow providers to share in savings achieved by coordinating patient care across all sites of care, inpatient and outpatient, and by providing higher quality care.


But then, on Oct. 20, CMS issued a final rule which, initially at least, seemed to appease many, including the American Medical Association and the American College of Physicians.


“We listened very carefully to the more than 1,300 comments we received on the proposed rule released this spring, and this final rule includes a number of improvements suggested by those comments that will strengthen the program,” said Donald M. Berwick, M.D., administrator of CMS, in a statement. Among those improvements were an increase in incentives (including more time for new ACOs to share savings but not to share losses), a sizable reduction (from 65 down to 33) in the number of measures used to assess quality, greater flexibility in start dates, and the elimination of the proposed requirement that 50 percent of primary care physicians be “meaningful users” of electronic medical records in order to participate.


Naturally, questions about ACOs still remained. “They’re trying to compress several generations of evolution in medical practice into just a few years,” said HIDA CEO Matt Rowan following release of the proposed rules in the spring. (June 2011 Repertoire.) “To go from a siloed healthcare delivery model to a collaborative one, to move from pockets of collaboration to [a system in which collaboration is] widespread or the most common delivery mechanism, would generally take generations. To do it in just a few years is asking a lot. You’re changing the fundamental culture of healthcare providers.”



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