Originally from Dispute Resolution Journal

This article discusses the Accountable Care Organization (ACO) concept enacted by Congress in the 2010 Patient Protection and Affordable Care Act, as well as its objectives in improving patient care at lower cost, and the incentives it offers to healthcare providers to meet those objectives. It also addresses the implementation of the ACO patient-care performance rules proposed by the Centers for Medicare and Medicaid Services. In addition, it considers the various types of legal issues that could lead to disputes and generate a need for ADR ser vices.

On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) announced proposed rules1 implementing the Accountable Care Organization (ACO) provision in Section 30222 of the Patient Protection and Affordable Care Act (Affordable Care Act),3 a component of the Medicare Shared Services Program (MSSP). Section 3022(a)(1) provides, in part:

(a) Establishment—(1) In general—Not later than January 1, 2012, the Secretary shall establish a shared-savings program (in this section referred to as the “program”) that promotes accountability for a patient population and coordinates items and services under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.”4 (emphasis added)

Restated concisely, ACOs approved by CMS will operate with CMS supervision under CMS rules and will be implemented to achieve these goals: (1) better health, and (2) better care at (3) lower cost. The proposed CMS rules clarify how ACOs under the Affordable Care Act could improve coordination and communication among doctors and hospitals, improve the quality of care that their patients receive, and also help to lower costs.