From IPA to ACO: The Queens County Medical Society Accountable Care Organization

Tuesday, February 8th, 2011
This post was written by Jessica Fornarotto

The Queens County Medical Society IPA is the chassis driving its evolution into an accountable care organization, explains Jeffrey R. Ruggiero, Esq., a legal advisor for Queens County Medical Society’s ACO development process.

Why did the Queens County Medical Society form an independent practice association (IPA)? And what is an IPA? An IPA traditionally is an independent practice association, which is a rather loose affiliation of physicians that come together for the purpose of engaging in joint managed care contracting. In this case, that is not what this IPA is going to be doing. This IPA merely is a legal structure that forms a conduit or a vehicle for the purpose of evolving into an accountable care organization (ACO). At this stage, the Queens County IPA will not be engaging in commercial managed care contracting, but rather developing an organizational structure for the purpose of participating in the CMS Shared Savings Program as an ACO.

The difference between an IPA and an ACO is that IPAs have traditionally been loosely structured. That’s probably the reason why they’ve had some mixed success, because they aren’t sufficiently integrated to be able to achieve efficiencies and utilization management and therefore have not done well economically.

An ACO has to be a much tighter structure. There has to be buy-in by the participants and agreement to formulate and abide by utilization standards, which need to be strictly imposed on the participating physicians. They also have to agree in advance to clinical protocols and guidelines and to the use of health IT and electronic health records (EHRs). These are all components that may or may not exist in a traditional IPA loosely affiliated structure.

The Queens County IPA/ACO will be managed and operated strictly by physicians for the benefit of physicians, and that’s an important feature. Once the physicians are selected that are capable of managing and leading other physicians, you have to empower those physicians to fulfill those obligations and take on the task of leading and managing their fellows and colleagues in this effort.

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