With the Centers for Medicare & Medicaid Services (CMS) predicting the number of affordable care organizations (ACOs) will double to 300 by the end of 2012, it is time to start thinking about what you and your providers need to do to become Medicare ACO partners.
How does a Medicare ACO function and how will it potentially affect your office?
Born of the Affordable Care Act, Medicare ACOs are made up of a group of Medicare providers and suppliers. Under the ACO, the providers and suppliers agree to band together, coordinating care, documentation, and billing for patients, improving quality and cost savings in the process. Providers, payers, and newly established groups have applied to CMS for approval to start an ACO, which if approved must operate for at least three years.
An ACO’s quality performance is evaluated in five areas: care coordination, patient safety, preventive health, patient/caregiver experience, and at-risk population/frail elderly health.
CMS’ Medicare Shared Savings Program (MSSP) bases financial incentives to ACOs on successful cost reduction via care coordination. Under the MSSP, ACOs serve a minimum of 5,000 beneficiaries and must provide enough primary care physicians to easily serve the population. Before applying for MSSP status, an ACO must establish legal and governance structures, cooperative clinical and administrative systems and a shared savings distribution protocol.
Incentive payments are based on comparing an ACO’s annual incurred costs relative to CMS determined benchmarks and ACOs can choose to be reimbursed based on a “one sided” or “two sided” model. The one sided model allows the ACO to share a maximum of 50 percent for the first two years and savings or losses the third year. The two sided model allows a maximum of 60 percent sharing of savings and losses for all three years. Shared loss grows from 5 percent to 10 percent over the three year period.
A key to success is the communication of patient information, which adds a new perspective on current, interoperative electronic health record (EHR) systems. ACOs were ideated to encourage seamless treatment of patients by teams of providers from different entities and disciplines. Universally reliable documentation and classification of each patient may help providers meet incentives while providing improved quality of care.
If you are updating your EHR, investigate its ability to capture and communicate the information needed by other practices, physicians, and providers who may be joining your practice in a future ACO.
November 26th, 2012
Healthcare Payer News reports a new accountable care health plan from Aetna and Aurora Health Care will offer a price guarantee to employers, many of whom may see an average reduction of 10 percent based on their past claims expenses. The Aurora Accountable Care Network’s price guarantee may be the first offering of its kind, and is designed primarily to meet the insurance needs of small- and mid-sized employers in Wisconsin.
August 9th, 2012
Citing cost and speed benefits, cloud computing experts say health care will soon follow other industries in assimilating cloud-based computing to store and maintain patient records and claims, reports American Medical News. This could mean big changes for coding and billing practices. (more…)
July 26th, 2012
The Centers for Medicare & Medicaid Services (CMS) reports, as of July 1, the addition of 89 new, approved Accountable Care Organizations (ACOs), bringing the total number of these new health care delivery systems to 154, covering 2.4 million beneficiaries.
The ACO model is formed by groups of doctors and other health providers who have agreed to work together to coordinate care for people with Medicare. According to CMS, those participating in an ACO agree to take responsibility for the quality of care they provide in return for the opportunity to share in savings realized through high-quality, well-coordinated care.
The program is voluntary, but can provide a payback. Federal savings from the initiative, which will be shared with successful ACOs, is expected to be $940 billion over four years. The Medicare Shared Savings Program (MSSP) and other initiatives related to ACOs are a result of the 2010 Affordable Care Act.
To ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely, an ACO must meet 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.
The selected ACOs operate in a wide range of areas across the country and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, CMS said. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving.
July 13th, 2012
Providers curious about the Medicare Shared Savings Program (MSSP) and the Advance Payment Model (APM) are invited to join a national provider call on July 31, from 1:30 to 3 p.m. EDT. The Centers for Medicare & Medicaid Services (CMS) says experts will provide an overview and updates to the MSSP and APM application processes for the Jan. 1, 2013 MSSP start date. (more…)