Maybe you haven’t heard much about accountable care organizations (ACOs) lately. Don’t think the idea is going away. An undercurrent of activity continues, though federal regulations are still not available.
Educate yourself about the concept and stay abreast of ACO formation in the state because all agree physician leadership will be an essential element. Even if you are an independent physician, you can be part of the changes ahead.
“A physician may participate in a contracting organization which becomes an ACO, much as he or she would participate in an IPA or PHO in earlier days,” said Tom Neal, attorney with Krieg DeVault. But physicians must understand that an effective ACO an organization needs to be clinically integrated, follow best practices and share some risk in payment models, Neal said.
The ISMA can help you. A new ACO Web page is available on the ISMA website. There you’ll find news articles, commentaries, reports, white papers and other materials to keep you current on national thinking and planning for ACOs and clinical integration.
Accountable care organization or ACO:
A clinically integrated network of physician groups or physicians and hospital(s) focused on managing patient care to meet cost and quality targets. Incentives – from cost savings – are distributed for achieving those goals. ACOs maintain a strong primary care network, share patient health care information and adopt common treatment protocols. Under Medicare, an ACO must provide care for a minimum of 5,000 patients for at least three years.
The AMA adopted principles for ACOs at its interim meeting last November. They include calls for ACOs to be voluntary and physician-led with goals aimed at increasing access while improving the quality and efficiency of care.
See the AMA principles on the AMA website.
Also, see a “How to” manual the AMA produced to help you navigate through ACOs and other models emerging from health care reform. It’s available to AMA members and nonmembers here.
The Centers for Medicare & Medicaid Services (CMS) Physician Group Practice Demonstration has announced results from the project that involves 10 large physician groups from New Hampshire to Washington state.
Marshfield Clinic’s investments benefit patients
- A well developed electronic health record
- A 24/7 telephone nurse advice and triage system
- Anticoagulation clinic
- Congestive heart failure clinic
- Cholesterol management programs
- A well-established telemedicine initiative
Read a press release from Marshfield Clinic detailing its success here.
Testing the ACO concept, the project showed all 10 groups met at least 29 of 32 goals, saving money on readmissions and ED visits and improving the quality of patient care. The Marshfield Clinic in Wisconsin, earned $16.2 million in performance bonuses.
Find a Medscape report about the project on the Medscape website (must register).
In addition, CMS sent data on cost and quality to 36 medical groups with more than 5,000 patients from 12 metropolitan areas. The reports represent the type of data that will become common with ACOs.
See answers to questions on these Quality and Resource Use Reports (QRUR) here.
Embracing the ACO idea
American Health Network (AHN), which is becoming an ACO, received a QRUR from CMS showing the large practice is on a level comparable to Marshfield Clinic.
“We delivered care that was a little over $1,700 per Medicare patient per year less than expected,” said Ben Park, M.D., AHN’s president and CEO. “The savings, which would presumably flow to our ACO, came as one might expect – from lower utilization of hospital inpatient beds, emergency room visits and post-acute care.”
AHN fell short on quality indicators like diabetic eye screenings, urine micro albumin testing and mammograms. “We already have a process in place to improve on micro albumin and mammograms,” explained Dr. Park. Marshfield Clinic’s head of telehealth is working with AHN’s ophthalmology group on a telehealth solution for diabetic eye screens.
Franciscan Alliance, previously called Sisters of St. Francis Health Services, is focused on clinical integration through ACOs and greater coordination and collaboration internally. The name change is indicative of this action.
“We have a variety of initiatives in place to drive efficiency and effectiveness of care,” said Al Tomchaney, M.D., chief medical officer. “Over the past 18 months, we have developed programs and best practices that have been shown to reduce infection rates and improve the process of care, in addition to adopting a variety of evidence-based clinical guidelines.”
Jim Callaghan, M.D., president of Franciscan Saint Anthony Health in Michigan City, said, “We embrace ACO activity because we welcome being accountable for our health outcomes and our costs. And physician leadership and engagement is an important part of our ACO readiness.”
Dr. Callaghan illustrated that readiness by noting the large system has:
- Successful capitation experience with a sizable Medicaid population
- A robust electronic medical record
- Large groups of employed physicians engaged in accountable care
- Positive experience with value-based purchasing and Medicare-mandated standards of care
ISMA Reports will alert you when CMS guidelines are available. Meanwhile, advise the ISMA if your organization or one you know is forming an ACO. Please contact Adele Lash or give us a call.