On October 20, the long awaited accountable care organization (ACO) final regulation was released today. The ASA Ad Hoc ACO Taskforce along with ASA staff are working to analyze the 696 page final regulation.  As analysis of the final regulation is completed, ASA will provide information to members on what role, if any, anesthesiologists will be able to play in ACOs.     

In ASA's formal communication on the original proposed rule, then ASA President Mark A. Warner, M.D., stated "A decidedly chronic disease management focus, a primary care centered model and a lack of any attention to improving costly acute inpatient surgical management, combine to inhibit surgical specialists and anesthesiologists from actively participating in ACOs." In addition, the original proposed rule lacked a role for anesthesiologists within an ACO. In that communication to CMS, for the first time the innovative surgical home concept was introduced to CMS by ASA. 

The Patient Protection and Affordable Care Act (PPACA) seeks to improve the quality of health care services and to lower health care costs by encouraging providers to create integrated health care delivery systems. One delivery system reform is the Medicare Shared Savings Program under section 3022 of PPACA which promotes the formation and operation of accountable care organizations (ACOs). The establishment of ACOs is just one of many delivery system reforms that are part of PPACA.

Accountable Care Organizations have the potential to redefine how healthcare providers both deliver care and receive compensation for their services. In the same way that risk-bearing managed care contracts altered physician-physician and physician-facility relationships in the 1990’s, ACOs, where implemented, will as well.

696 page final regulation 

CMS provided document comparing the proposed rule versus final rule

Medicare Program; Final Waivers in Connection with the Shared Savings Program 

Revised FTC ACO antitrust statement 

ASA's comment letter on the proposed rule