ACOs – We Already Have Them – It’s Called Your Local Critical Access Hospital

It’s interesting to see the trade periodicals fill with articles about Accountable Care Organizations (ACOs), how to structure them, how to ensure they don’t run afoul of anti-trust laws, how to allocate savings and on and on ad nauseum.

Having staked our niche largely in rural and tertiary markets, we get to see effective ACOs at work on a daily basis. They are called Critical Access Hospitals. Sure there may be considerably more complexity in “organizing” care in a community of 2 million residents versus 6,000 however, the last I checked care is still generally delivered one patient at a time. When you take a big picture, historical view of Healthcare in this country it has always been driven by the primary care physician and his/her knowledge of the patient, their medical history and their immediate and potential future needs. Couple the physician’s individual patient knowledge with the resources and facilities available in today’s Critical Access Hospitals and you have the template for what is trying to be accomplished in larger markets.

Critical Access Hospitals normally span the entire continuum of care. They act as the access point (24-hour Emergency Department), stabilize the patient in a short-term inpatient stay, have relationships with Regional Hospitals to transfer complex conditions, and discharge to the most appropriate level of care (Swing-Bed (SNF), Home Health, Home, Outpatient) all of which they offer. Additionally, they have been very adept at adding specialty physicians/clinics on a weekly, semi-weekly or monthly basis to handle post-acute follow-up locally. They don’t receive the headlines of Mayo or Kaiser Permanente; they just effectively provide the service.

ACOs in my view are simply a government incentive to go back to the future. Focus on caring for people like they are your next door neighbor and not HIPPA ID 23462, ensure they are given personal care and empathy every step of the way, and organize all the healthcare services to accomplish the only goal that really matters – help the patient get better and return to their prior level of function.

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