title: Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.
abstract: In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.
authors.affiliation: Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Watnick
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Rachel
authors.initials: R
authors.lastname: Shaffer
authors.forename: Jula
authors.initials: J
authors.lastname: Inrig
authors.forename: Sharon
authors.initials: S
authors.lastname: Moe
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D017046:Cost Savings; D033161:Government Regulation; D017048:Health Care Costs / Q000331:legislation & jurisprudence; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D017146:Models, Organizational; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D011787:Quality of Health Care / Q000331:legislation & jurisprudence; D012052:Reimbursement, Incentive / Q000331:legislation & jurisprudence; D006435:Renal Dialysis / Q000191:economics; D014481:United States