By Ben Assad Mirza, Esq., LLM, MPHA

As a healthcare practice, many have joined or are looking into joining an ACO (Accountable Care Organization). Here are some insider tips regarding ACO transparency to its members:

Five things to Know – Understanding the inner workings of an ACO:

1. Legal Entity – An ACO is a legal entity just like any other; it can be structured as a corporation, a partnership, an LLC, under applicable state or federal laws. At first, it may appear to be very similar to any other corporation, but it is really not; many other rules apply.  

2. Mission – An ACO’s mission must be in furtherance of providing quality healthcare, increasing patient access to healthcare, and with an eye toward sharing in the savings generated by the plan or the program.

3. Governing Body – An ACO has to have a separate and unique governing body, such as a board of directors or managers. The ACO participants must be given the opportunity for “meaningful participation” in the ACO’s governance. If it is to be deemed a physician-owned ACO, at least 75% of the ACO must be owned or controlled by the physicians.

4. Controlling the ACO – The ACO’s have voting powers just like any other corporation, but they are also required to maintain a “conflict of interest policy” that applies to the members of the governing body. They are required to be transparent, to disclose conflicts, and to disclose the methodology of how profits or Medicare savings are divided among its participants.

5. Healthcare Alignment – The ACO is required to maintain a senior level member who is a physician and a medical director of the organization. This position is not required to be full time, but it is responsible for clinical oversight and for overseeing and establishing the quality assurance and improvement programs of the ACO.

If you would like to find out more about what the rights, responsibilities and obligations of an ACO and its participants are, visit www.MirzaHealthLaw.com or call/text Ben Mirza at (954)445-5503 or email BAM@MirzaHealthLaw.com.