How Sleep Medicine Fits in ACO’s

Fariha Abbasi-Feinberg, MD, FAASM, member of AASM Board of Directors, has had a 25-year career in sleep medicine and has many insights to share with Pulmonary/Sleep providers. She currently practices with an Accountable Care Organization (ACO). 

An ACO is “is a group of providers that coordinates care for a specific group of patients. The goal is to improve health outcomes while keeping costs in check. ACOs focus on preventative care and reduction of costly hospitalizations.” And while most APPs in Pulmnary may not think this term concernes them, many providers work within systems that are actually part of an ACO.

Fariha notes that fifty-eight percent of all community hospitals nationwide, and even a higher percentage of university centers, are part of an ACO. “Your day-to-day activity and compensation may not yet be tied to ACO outcomes, but at some point this may change, and being proactive and informed is important.” 

So how does sleep medicine fit into the ACO Model? Fariha explains: 

The manner in which specialists deliver services profoundly influences the ACO’s capacity to enhance quality and manage costs. Specialty care is significantly more expensive than primary care. In most ACOs, the majority of specialty care is provided outside of the ACO network. ACOs have therefore become increasingly interested in connecting with specialty physicians. ACOs that employ specialists are looking at new types of arrangements. For instance, some ACOs require that referrals be first discussed between the primary care provider and their employed specialists in a “curbside consult” to see if the PCPs can manage more care themselves. This is wonderful for patients because they can avoid both long wait times to see specialists and additional copayments. In some ACOs, specialists educate their primary care colleagues in a more formal fashion, providing the tools to help them manage patients.

The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have also presented possible opportunities. The AMA has designed a program called Payments for Accountable Specialty Care (PASC), which allows primary care and specialty physicians to work together. The specialist would take responsibility for delivering services to improve outcomes and/or reduce avoidable spending. This is designed to improve services for the patient, and the specialists would receive an Enhanced Condition Services (ECS) payment in addition to the standard Medicare fee-for-service payment.

Sleep medicine could fit into this model effectively. Studies have shown that treating sleep disorders lowers health care costs. We have several options for providing cost-effective care. Our remote monitoring systems lend themselves perfectly to screen our population of patients and improve outcomes. We can help educate primary care providers to manage some sleep disorders effectively. With millions of undiagnosed patients with possible obstructive sleep apnea, we need to provide better access to care. We should work together with our primary care colleagues. Integration of sleep medicine into an ACO could be an interesting possibility.

The evolution of care models is a continuous process. ACOs may simply represent a chapter in the ever-evolving narrative of health care. To be prepared for the next chapter, we must actively engage in learning and participation.

The Association of Pulmonary Advanced Practice Providers (APAPP) works to advance the profession of APPs in Pulmonary Medicine. We actively seek out opportunites from trusted organizations like AASM to help educate our members on news in our field. 

See the full article from the American Academy of Sleep Medicine (AASM) HERE.