Accountable Care Organizations PDF Print E-mail





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On April 1st, 2016 new rules will be in effect for how Medicare will pay for knee replacement surgeries. Drastic discrepancies among costs and quality of procedures have led to Medicare instituting a flat fee for knee replacement surgeries and follow up care.  This may seem scary to some, but there are benefits for the hospital that is able to complete the surgeries and follow up care in a cost-effective manner.


“Depending on the participant hospital’s quality and episode spending performance, the hospital may receive an additional payment from Medicare or be required to repay Medicare for a portion of the episode spending.”  From Centers for Medicare and Medicaid services own web page.  


In order to help the hospitals with costs and continue to provide the highest quality care possible, they have also relaxed the requirements for use of telehealth when providing follow up care to knee replacement patients.  Under the new model, Medicare will allow hospitals to use telehealth services such as video conferencing between the providers and patients even if the beneficiary is not in a rural area and the consultation can even be done in the patient’s home. Telemedicine services can be used when a follow up appontment is needed to check in on a patient and observe the range of motion in the affected knee.  



Secure Telehealth is the simplest and best solution for telehealth sessions between a health care provider and a patient in his or her home.  We will provide the HIPAA compliant software and give demonstrations on how best to use it for telehealth for both the providers in the hospitals and the patients in their home. We will also sign a Business Associate Agreement with the providers in order to be able to provide technical support if needed.  





CMS waives Telehealth geographic restrictions for ACO's

WASHINGTON, DC – Wednesday, March 11, 2015 – The American Telemedicine Association (ATA) applauds the decision by the Centers for Medicare and Medicaid Services (CMS) to allow Accountable Care Organizations (ACOs) to use telehealth services.  The decision was made as part of the release of a new payment and care delivery model:  the Next Generation Accountable Care Organization (ACO).  The decision extends coverage for telemedicine services to millions of Medicare beneficiaries. 

The decision is particularly significant because under this new model, Medicare telehealth services can be covered without regard to longstanding rural and institution restrictions, requiring a beneficiary be located in a rural area and served at a health facility.  For the first time, telehealth coverage will be extended to 80 percent of Medicare beneficiaries living in metropolitan areas and from any service originating site, such as their home.

This decision gives Next Generation ACOs the ability to cover and reimburse for telehealth services just like Medicare Advantage (managed care) plans do now.

“For nearly four years, ATA has urged CMS to waive all the Medicare restrictions for all ACOs,” said Jonathan Linkous, CEO of ATA. “This is an important change in CMS policy and attitude. We hope it will encourage CMS and Congress to further open up all value-based payment plans to telehealth.”


CMS encourages ACO's to use Telehealth in Final Rule published in November, 2011

ACO's must define a process to "coordinate care, such as through the use of telehealth, remote patient monitoring, and other enabling technologies."  from page 26 of  "42 CFR Part 425" published in the Federal Register.   

Further guidance on ACOs' use of telehealth is found on page 29 of the document:

"We explained in the proposed rule that coordination of care involves strategies to promote, improve, and assess integration and consistency of care across primary care physicians, specialists, and acute and post-acute providers and suppliers, including methods to manage care throughout an episode of care and during its transitions, such as discharge from a hospital or transfer of care from a primary care physician to a specialist."


Secure Telehealth provides an inexpensive technology for specialists consults during an episode of care, and for managing care in-home during transitions such as post-discharge from a hospital.

 Secure Telehealth helps you meet 11 of the NCQA 2011 PCMH Standards

1A1 - Same Day appointments (even if the provider or specialist is at another facility)

1B1 - After hours appointments (even if the provider is at home)

1C4 - Two-way communications between Patients/Families and the Practice

1F3 - Provide BiLingual services (across facilities)

1G2 - Holding regular team meetings (across facilities)

1G4 - Training care teams (across facilities)

3C2 - Collaborate with the Patient/Family to develop a care plan

3D5 - Assess patient response to medications (from home)

3E4 - Perform Patient-specific checks for drug-drug and drug-allergy interactions (from home)

4A5 - Provide self-management tools to record self-care results (check-in with patients at home)

4B3 - Arrange or provide treatment for MH and Substance Abuse disorders (same day treatment with off-site provider via telehealth)


Behavioral health providers should consider integrating their specialty services into Accountable Care Organizations via face-to-face video interactions from Secure Telehealth.

"Any ACO that fails to properly include behavioral health providers is destined to continue struggling with a significant share of otherwise unmitigated chronic care costs so the value proposition should be clear. In order to achieve a high performance health system that is organized to attain better health, better care, and lower costs, the behavioral health needs of patients and their families must be met with as much ingenuity, quality and precision as other conditions." - from an AHP Healthcare Solutions Article found here.

Random thoughts from Secure Telehealth:

1. Behavioral Health Care provides the best opportunity of all the specialties to be effectively integrated into an ACO via telehealth video sessions because behavioral health providers don't need to touch their patients to treat them.   We recommend that behavioral health providers market the concept of providing their expert services to newly forming ACO's via (Secure) Telehealth. 

2. Medicare limits Fee-for-Service Payments for Telepsychiatry to rural settings.  Currently, Medicare only pays for tele-mental health sessions when the sessions are conducted with medicare beneficiaries who are presenting from approved facility types in non-metropolitan areas.  How might Medicare limit or restrict tele-mental health consults geographically in an ACO setting where payments and funding are more integrated?

3. Will ACO's respond to the need to integrate services simply by hiring the behavioral health expertise they need, or will they reach out to established BH providers with sub-contracts?  As Patrick Gauthier of AHP Healthcare Solutions says here; "Mental Health and Substance Use Disorder providers need to get active in their own networking and marketing. Becoming an active stakeholder (if not shareholder) in an ACO will mean “selling” your services into the mix and negotiating a stake. Serving as an ancillary provider in a peripheral network similarly requires marketing and contracting. ACOs are – from the beginning – a new business model that will require new business relationships and that’s a very active process as opposed to a passive one."

4. Secure Telehealth recommends that Behavioral Health providers integrate their speciality services into Accountable Care Organizations with real-time, face-to-face video (telehealth) interactions.


Not sure how ACO's will affect you?   Check out this resource from the National Council of Community Behavioral Health. 

This resource outlines the key elements of the final rules and their implications for behavioral health providers. It answers the key questions:

  • What really makes an ACO?
  • Who can create and join an ACO?
  • Where do behavioral health providers fit in?

The report also explains how behavioral health organizations can “ride the wave” and make the case for their participation in ACO. 


Here is another ACO publication from the National Council 


Here is a good Primer on ACO's from NPR's Jenny Gold.  Excerpts:

"What is an Accountable Care Organization?

ACOs would make providers jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work they'd have to seamlessly share information. Those that save money while also meeting quality targets would keep a portion of the savings. But some providers could also be at risk of losing money."

How would ACO's be Paid?

"In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid more when they give patients more tests and do more procedures. That drives up costs, experts say. ACOs wouldn't do away with fee for service but would create savings incentives by offering bonuses when providers keep costs down and meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers would get paid more for keeping their patients healthy and out of the hospital."   

Read more here:


Next Steps: 

1. Contact Secure Telehealth (email This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) for a free, live demonstration so you can see the quality for yourself.  

2. Partner with a newly forming ACO.

3. Work out your EMR Strategy with your potential ACO partners so patients' health records are seemlessly shared.


Last Updated on Thursday, 07 April 2016 15:59