Nurses should assume leadership roles in Accountable Care Organizations

The Centers for Medicare and Medicaid Services (CMS) has asked U.S. healthcare organizations to submit ideas regarding the formation of Accountable Care Organizations, and the American Nurses Association (ANA) has responded with a letter outlining several elements that it feels are essential for inclusion.

“This is a pivotal moment to restructure the payment systems, quality assurance enterprises, and the antiquated hierarchy of healthcare professionals to reward truly interdisciplinary care,” chief executive ANA officer, Marla J. Weston, PhD, RN, wrote.

Accountable Care Organizations (ACOs) are a provision of health care reform under the Affordable Care Act that aims to facilitate better coordination and cooperation among healthcare providers, improving the quality of care Medicare beneficiaries receive and reducing unnecessary costs with a shared savings incentive.

Under this provision, ACOs that meet quality performance standards each year will be rewarded with a “share” of any saving that occur if Medicare beneficiary expenditures are a “sufficient percentage below a specified benchmark amount,” according to documents provided online by the CMS Office of Legislation.

In order to be successful, the ANA suggested six standards that ACOs must meet:

1. Nurse-led care coordination. Although it is thought to be an important concept, “coordination of care” is never adequately defined, according to the ANA. The organization suggests that CMS identify, measure and evaluate specific nursing services as a way to measure quality of care.
2. Adequate compensation for care coordination. The ANA recommends creating financial incentives for healthcare organization to hire RNs, and eliminating the common practice of lumping nursing costs under umbrella terms like “room charges” for reimbursement purposes.
3. Measuring the quality of care coordination using “nurse-sensitive indicators.” These could include the prevention of avoidable adverse events such as pressure ulcers, falls and medication errors using a tool such as the National Database of Nursing Quality Indicators, in order for ACOs to be eligible for savings.
4. Strong leadership from all healthcare professionals. Physicians, nurses and other healthcare professionals should be represented equitably in ACO leadership structures to encourage the type of interdisciplinary collaboration that more accurately reflects the “overlapping scopes of practice” necessary in providing true patient-centered care.
5. Inclusion of a wider segment of small, solo and nurse-led practices. Current eligibility requirements state that practices must have a minimum of 5,000 beneficiaries to participate in an ACO. The ANA suggests adding payment incentives that would reward accreditation and small practices ability to function within networks.
6. Measure patient satisfaction. The ANA recommends using the Consumer Assessment of Healthcare Providers and Systems as a model survey to better understand the patient experience, and thus improve clinical outcomes, patient retention, malpractice risk and employee satisfaction.

“Nursing is energized about the immense opportunity to improve the healthcare journey in America, and ANA sees the ACO as a new frontier,” Weston wrote.

The ACO program is projected to launch in January 2012. A CMS open door listening session is planned for Summer 2011. Interested stakeholders can find further information here.