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Accountable Care Organizations Stir Praise, Concerns

Professionals working for skilled nursing-facility providers express strong doubts that proposed accountable care organizations (ACOs) will benefit postacute facilities or their patients, according to new survey results published by Patient Placement Systems (PPS).

The survey also indicates that skilled nursing facilities (SNFs) do not clearly understand how they would participate in ACOs, and are thus slow to establish their ACO strategies.

“There has been extensive speculation about the impact of ACOs on nursing homes and other post-acute providers since CMS issued the draft rule in March,” said Doug Walker, vice president and general manager of Patient Placement Systems. “SNF professionals remain uncertain about how or if ACOs will work, and most believe that ACO rules and structures as defined by CMS would not improve patient care or benefit SNFs.”

The survey results support these observations:

  • Only 22% of SNF professionals agree or agree strongly that ACOs will be perceived as having improved patient care in five years.
  • Only 25% say that ACOs will benefit skilled nursing facilities.
  • Only 31% agree or strongly agree that “our organization has a clear understanding about how skilled nursing facilities will participate in ACOs.”
  • High percentages of respondents (between 14% and 21%) communicated their uncertainty by answering “don’t know” to these survey items.

This lack of clarity and doubt about benefits seems to be affecting how, and how quickly, SNFs are preparing for ACOs. Although 53% agree or strongly agree that developing an ACO strategy is a “high priority for our organization,” preparation still lags:

  • Just 22% of skilled nursing-facility providers have an ACO strategy prepared.
  • Fully 34% say they “don’t know” when their organization will develop an ACO strategy.
  • Just 27% expect to have a strategy within the next six months.

Walker did note one positive response: 69% agreed or strongly agreed that “even without formal ACOs in place, our skilled nursing facilities collaborate with hospitals to improve the continuity and quality of patient care.”

“That strong response seems to indicate that postacute providers are and will continue to work with hospitals and doctors to improve accountability and patient outcomes,” Walker said. “They are not waiting for a final ACO rule to start addressing the challenges of lowering costs and enhancing patient care.”

PPS administered the survey and compiled the results in July 2011. PPS invited SNF professionals by e-mail to take the online survey. The 154 respondents broke down by the following titles:

  • C-Level corporate executives: 20%
  • Other corporate executives: 16%
  • Facility administrators: 17%
  • Corporate directors and managers: 17%
  • Other facility professionals: 25%
  • Other: 7%

For more information about the survey and to request the complete survey results, please visit

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