Reality Bites: The Establishment of Accountable Care Organizations in Otolaryngology

Abstract

Although United States health care costs are significantly higher than any other industrialized country, we still lag behind many countries in health care equity and quality metrics. One feature of the Affordable Care Act that intended to address this was the establishment of Accountable Care Organizations (ACO). ACOs create a network of physicians that ostensibly will enhance care coordination among providers, improve patient experience and health outcomes, and lower overall costs. ACOs emphasize prevention and management of chronic diseases, and reward quality and cost-effective care, while attempting to move away from fee-for-service medicine. Unfortunately, although not always responsible for many of the metrics that determine cost or quality of care, physicians are largely held accountable for the delivery of high-quality and low-cost care. With otolaryngology having been slow to transition to this new payment model, it is imperative that we stay engaged and take a proactive role in this process because it has great implications on our patients' outcomes and our own practices. Several articles in this issue of American Journal of Rhinology & Allergy contain themes relevant to this type of change.First is an intriguing article by Barry et al.,1 who examined what the contemporary literature shows about early versus aggressive management of chronic rhinosinusitis (CRS) as it relates to patient experience, health outcomes, and overall cost burden. Their review demonstrated that early intervention with endoscopic sinus surgery in appropriately selected patients has the potential to improve outcomes and reduce the long-term cost burden of CRS.Besides early surgical intervention, medical management is another area that is likely to be affected by the ACO model. Aggressive medical management as a first-line therapy option may potentially improve clinical outcomes and reduce health care costs. Novel topical medicines in the treatment of CRS provide targeted therapy and reduce the adverse effects associated with systemic use of certain medications. Sodium hyaluronate has been described to promote wound and mucosal healing, but it has not been described in its use in CRS therapy. Cantone and Iengo 2 evaluated it use in combination with topical steroids and found improvement in symptoms, endoscopic examinations, and discomfort associated with CRS with nasal polyps (CRSwNP) compared with steroids alone.The impact that the quality metrics will have on physician reimbursements makes it imperative that otolaryngologists provide input into what specialty-specific performance measures are used. Dorresteijn et al. 3 reported on a newly developed severity metric, the Nasal Mucus Index. They studied the association of various inflammatory biomarkers and self-reported severity measures with the newly developed Nasal Mucus Index. The Nasal Mucus Index was found to correlate significantly with same-day interleukin-8 levels, polymorphonuclear neutrophils count, and Wisconsin Upper Respiratory Symptom Survey-21 scores. It is propose...

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“…The landscape for health care delivery and reimbursement has changed dramatically over the past decade 13,14 . The emphasis on cost‐effective and value‐based care has spurred initiatives that shift responsibility for cost containment to hospitals and providers through accountable care organizations and bundled payments 15–17 . Value‐based care initiatives have expanded from the primary care setting to surgical specialties, in particular through bundled payments, an episode‐based reimbursement model in which a fixed reimbursement provides compensation for all care associated with a particular surgical procedure 18–20 …”

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“…[3][4][5] Efforts within the United States to reign in health care spending include the passage of the Affordable Care Act (ACA) in 2010 and the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, which have dramatically altered the landscape for health care delivery and reimbursement. [6][7][8][9] As a result of these and similar initiatives, there has been a shift toward value-based care with hospitals and providers carrying greater responsibility for cost-containment through measures such as Accountable Care Organizations (ACOs) and bundled payments. 3,6,7,9 More recently, the emphasis on value-based care has extended from the primary care setting to increasingly influence surgical subspecialties, particularly through bundled payments, an episode-based reimbursement model, that are often based on providing a fixed reimbursement for all care associated with a given surgical procedure.…”

“…Efforts within the United States to reign in health care spending include the passage of the Affordable Care Act (ACA) in 2010 and the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, which have dramatically altered the landscape for health care delivery and reimbursement. 6-9 As a result of these and similar initiatives, there has been a shift toward value-based care with hospitals and providers carrying greater responsibility for cost-containment through measures such as Accountable Care Organizations (ACOs) and bundled payments. 3,6,7,9…”