The number of participants in Accountable Care Organizations (ACOs) has jumped significantly within the past three years, according to an ACC survey of 393 cardiologists. Of those surveyed, one out of five (21 percent) are already in an ACO, up from just 1 percent in 2011, and another 32 percent indicated a high likelihood of participating in an ACO in the future.

ACOs are defined as a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients with the goal of reducing health care costs. The ACO concept, which initially debuted around 2006, gained traction in 2010 with the passage of the Affordable Care Act and the inclusion of a provision directing the Centers for Medicare and Medicaid Services (CMS) to create an ACO “program” by no later than Jan. 1, 2012. Under the CMS program, each ACO has to manage the health care needs of at least 5,000 Medicare beneficiaries for a minimum of three years.

Given the relative newness of the ACO concept, it’s not surprising that 75 percent of survey respondents already participating in an ACO have only been doing so for two years or less. Hospital-owned practices were more likely to be participating in an ACO, followed by medical school-owned (25 percent) and physician-owned (19 percent). The majority of ACOs included a medical group (94 percent), hospital (88 percent) and a specialist group (69 percent). Nearly 40 percent of ACOs involved an integrated delivery system. Nursing homes (19 percent), federally qualified health centers (13 percent) and rural health clinics (6 percent) were less common.

Also not surprising given their short history, more than half of survey respondents (63 percent) said the jury is still out in terms of satisfaction with their ACO. Only 19 percent were very satisfied with their ACO, while another 19 percent said they were not satisfied. Respondents were also unclear about the overall impact of ACOs on quality improvement, with 43 percent saying they were undecided. Only one out of three survey respondents felt ACOs have a strong impact on quality improvement, while one out of four said ACOs have no impact.

Despite the uncertainty, there appears to be a broad level of awareness with ACOs among cardiologists in general. More than 70 percent of survey respondents indicated some level of familiarity with the ACO concept, even if they weren’t already participating in a program.

In general, the ACC is supportive of ACOs and other collaborative payment models that make it feasible for physicians and hospitals to meet the triple aim of better care, improved outcomes and lower costs. The College will be closely watching the growth in ACO participation and will be looking for opportunities to gauge cost-savings and impacts on quality improvement over time. The College will also continue to work with CMS and the Centers for Medicare and Medicaid Innovation on other innovative payment efforts that allow providers to improve care.

Keywords: Rural Health, Traction, Nursing Homes, Medicaid, Centers for Medicare and Medicaid Services, U.S., Patient Protection and Affordable Care Act, Quality Improvement, Delivery of Health Care, Schools, Medical, Health Expenditures, Personal Satisfaction, Accountable Care Organizations, Medicare, Cardiology Magazine, ACC Publications

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