Understanding What the ACA Means for Ophthalmology

American Academy of Ophthalmology 2013

Roger F. Steinert, MD; Nancey K. McCann; Brock K. Bakewell, MD


November 22, 2013

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In This Article

Let's Start With ACOs

Roger F. Steinert, MD: Hello. I am Dr. Roger Steinert, Director of the Gavin Herbert Eye Institute and Professor and Chair of Ophthalmology at the University of California Irvine. Welcome to Medscape Ophthalmology Insights, coming from the American Academy of Ophthalmology (AAO) meeting in New Orleans. Joining me today are Nancey McCann and Dr. Brock Bakewell. Nancey is Director of Government Relations at the American Society of Cataract and Refractive Surgery (ASCRS). Dr. Bakewell is Chair of the Government Relations Committee at ASCRS. He practices in Tucson, Arizona, specializing in cataract and refractive surgery and corneal disease at the Fishkind, Bakewell & Maltzman Eye Care and Surgery Center. We will be discussing the Affordable Care Act (ACA) and how it will affect ophthalmology as well as the formation of Accountable Care Organizations (ACOs). I would like to start by asking Nancey to help us with this alphabet soup. What exactly is an ACO?

Nancey K. McCann: The ACO is part of the provision under the ACA, which actually is the Medicare Shared Savings Program. It was a pilot demonstration that has been expanded, and the concept is to try and control costs and quality of care by coordination between primary care providers and specialists. It started with the ACA but it has grown. Depending on where you are in the United States there may be 1 or 2 ACOs. In some markets, such as Boston, there are 6-8, and in some parts of the country there are none at all. It is an effort to improve quality outcomes and control costs in the system. If there is money saved at the end of the year, the savings go back to the physicians who participate in the ACO. There is a lot of confusion about whether it is based on fee-for-service. It is not like a traditional health maintenance organization (HMO) that tries to control the care by keeping the patient inside the HMO. The patient can go outside of the ACO at any time. They are not required to stay in the ACO and see only those providers. It is important to clarify that.


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