A Nurse Practitioner's View

With all the  recent  discussion on the Affordable Care Act (ACA) being heard before the Supreme Court, I wanted to discuss one of the programs that was borne from the ACA. The  Centers for Medicare & Medicaid  (CMS) define Accountable Care Organizations (ACOs) as "... groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors." Wow, this sounds great so far, and seems to be congruent with nurse practitioner-partnered care, what could be wrong with this model? Read on. The "ACO Professional" is  defined , "...as a physician (as defined in section 1861(r)(1) of the Act) or a practitioner described in section 1842(b)(18)(C)(i) the Act (that is, a p...

There is an interesting trend that I'm observing and don't necessarily see how this is going to turn out. I'm seeing more and more nurse practitioner's opening their own autonomous practices. Many of these offices set out to offer care that is personalized, covered under insurance, and of course high-quality. I'm also seeing more NP specialty/sub-specialty practices such as house calls, incontinence, and women's health. This is in a time when more physician practices are joining together in these conglomerations that aren't necessarily tied to hospitals. You'd be hard pressed to find a solo primary care physician these days yet nurse practitioner solo practices are popping up. The talk about the formation of accountable care organizations can be attributed to health care reform and the spurring of large multi-physician practices. What to make of this? I honestly don't know. Many people and patients have said to me "you should start your own prac...