Call Yourself an ACO? Prove It

Cheryl Clark, November 16, 2011

Healthcare providers that boast they're accountable care organizations may now have their services vetted by the National Committee for Quality Assurance, which on Monday announced a three-tiered accreditation program to verify and score those claims.

"There's lots of organizations who are going to call themselves an ACO," Raena Grant Akin-Deko, the NCQA's Assistant Vice President for Product Development tells HealthLeaders Media. "But we think that from a patient or purchaser perspective, it might be hard to tell which organizations really are going to take accountability."

So the committee is rolling out a set of seven overarching criteria that it expects ACOs to master, and will confirm their ability to provide that quality of care with onsite surveys starting in March. Organizations can apply starting Nov. 21.

"Part of the rationale of why we developed this program was to give folks out there who will be using the services of these entities a level playing field," Akin-Deko says. "We want to be able to tell an organization that has the capabilities of being an ACO from one that might just be putting the label on their organization."

ACOs that submit to inspection would agree to have their status, and level of accountable care provided, posted on the NCQA website, much like quality data that can now be seen on the Centers for Medicare & Medicaid Services' HospitalCompare.

For example, organizations will have to demonstrate that they have a sufficient number and appropriate selection of types of practitioners for the community they purport to serve. They may, for example, demonstrate that they have the ability to arrange for a patient to see a provider within a certain number of hours to avoid a trip to the emergency room, Akin-Deko says.

Additionally, the ACO would have to have a method for patients to submit complaints.

Elliott Fisher: some reservations

Elliott Fisher, MD, director of the Center for Population Health at Dartmouth Medical School, tells HealthLeaders that he is "completely supportive of the goal (the NCQA) is trying to achieve, but has some reservations.

"I'm concerned that it's early in the development of this to set in place a set of rigid structural requirements that may or may not be predictive of high performance.  It may lock out some of the most creative innovative organizations and institutions from participating in this program."

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