New guidelines for Medicare Accountable Care Organizations (ACO) may help physical therapists become more important players in America's healthcare system.
However, physical therapists are currently not categorized as ACO professionals by the Secretary of Health and Human Services (HHS).
The new guidlelines will, hopefully, add clarity to vague promises and hopeful expectations currently voiced by Medicare officials:
"An ACO will be rewarded for providing better care and investing in the health and lives of patients," said CMS Administrator Donald M. Berwick.Leaders in the commercial healthcare marketplace are more forthcoming. Karen Ignani, CEO of America's Health Insurance Plans, said ACOs presented...
"ACOs are not just a new way to pay for care but a new model for the organization and delivery of care."
"an opportunity for Medicare and Medicaid to build on the successes of the innovative payment systems that exist in the private marketplace today to improve the quality and safety of patient care and help put the health care system on a sustainable path."I can't help but think that Ms. Ignani was speaking of innovative delevery models, like the Virginia Mason experiment from 2006, where patients with lower back pain went first to physical therapy, skipping the expensive MRI and neurosurgical referral.
Fee for service rewards greater productivity but not innovation.
The more cost-effective Virginia Mason became, the bigger financial hit the medical center took.
"Everyone gained but Virginia Mason," says its chief of medicine, Robert Mecklenburg.The promise of the ACO model is more experimentation like Virginia Mason but the risk is that providers will try to consolidate to gain market share and drive up prices.
Again, Karen Ignani:
"...ACOs could accelerate the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage.