Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH 03766, USA.
J Vasc Surg. 2012 Mar;55(3):875-82. doi: 10.1016/j.jvs.2011.10.116.
With the passage of the Affordable Care Act, accountable care organizations (ACOs) represent a new paradigm in healthcare payment reform. Designed to limit growth in spending while preserving quality, these organizations aim to incant physicians to lower costs by returning a portion of the savings realized by cost-effective, evidence-based care back to the ACO. In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a "seat at the table" will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs.
随着《平价医疗法案》的通过，问责制医疗组织（ACO）代表了医疗保健支付改革的一个新模式。这些组织旨在限制支出增长，同时保持质量，旨在通过将基于成本效益的循证护理所节省的部分成本返还给 ACO，激励医生降低成本。在这篇综述中，首先，我们将探讨 ACO 在之前控制医疗保险支出的尝试（如可持续增长率和管理式医疗组织）的背景下的发展。其次，我们描述了 ACO 的演变、证明其可行性的示范项目以及它们当前的组织结构。第三，因为质量指标是 ACO 使用和实施的核心，所以我们描述了目前在血管外科学中设计、收集和解释质量指标的努力。第四，因为在这些努力中，血管外科医生“在桌旁的席位”将是成功的一个重要关键，所以我们讨论了血管外科医生如何参与和领导 ACO 内的工作。
