Blog by: Melanie T. Gura, RN, MSN, CNS, CCDS, FHRS, FAHA, AACC and Suzanne Hughes, RN, MSN, CNS, FAHA, FPCNA Under section 3022 of the Patient Protection and Affordable Care Act, the Department of Health and Human Services must create by 2012 a Medicare “shared savings program” that permits groups of providers who meet certain statutory criteria to be recognized as Accountable Care Organizations (ACOs). Currently, our healthcare system pays hospitals to fill their beds and provide more tests and procedures. The ACO will shift the paradigm from a volume-based health delivery system to becoming a value-based health care system. An ACO is an organization of healthcare providers who agree to be accountable for quality, cost and overall care of patients assigned to the organization. While this concept continues to evolve, ACOs will bring together primary care physicians, specialists, advanced practice nurses (APNs), physician assistants, hospitals and other healthcare providers to share in the responsibility of coordinating patient care. The member providers will then share in any savings if quality and cost goals are reached. These ACO members will work together to deliver evidence-based, patient-centered care and keep patients healthy and out of the hospital. Incentive payments will be judged on a 12-month period, where participating ACOs will be required to meet specified quality performance standards to be eligible for a percentage of the savings from Medicare. Healthcare providers will still receive payment for providing services, but they’ll also receive “shared savings” or payments for together achieving spending and quality targets. A number of health reform provisions directly address primary care and impact APNs working not only in a primary care setting but also those certified as geriatric, pediatric, psychiatric and women’s health APNs. The ACO will create opportunities for APNs to impact the quality of clinical care, allow improved access to healthcare for the medically underserved, and do so in an efficient, patient-centered and cost-effective way. Melanie T. Gura, RN, MSN, CNS, CCDS, FHRS, FAHA, AACC is the Director of Pacemaker & Arrhythmia Services at NE Ohio Cardiovascular Specialists. Suzanne Hughes, RN, MSN, CNS, FAHA, FPCNA is the Director of System Population Health at Summa Health Systems in Akron, Ohio.