Accountable Care Organizations: 4 Physician Benefits

ACCOUNTABLE CARE ORGANIZATIONS:

4 PHYSICIAN BENEFITS

REVIEW: WHAT IS AN ACCOUNTABLE CARE ORGANIZATION?

The Affordable Care Act established provisions for accountable care organizations (ACOs) as one of several approaches to moving payment models from fee-for-service.

An ACO is a group of community physicians,

hospitals and other clinicians that come together to coordinate care as a healthcare organization.

ACOs operate under a payment and care delivery model in which provider payments hinge on certain quality benchmarks and reductions in the growth of the total cost of care for an assigned population of patients.

The group of care providers, which can include primary care providers, specialists and other heathcare service providers, share in the responsibility of meeting and reporting quality benchmarks as well as focusing on prevention and chronic disease management.

Incentives for participating in an ACO come in the way of shared savings (i.e. reductions in the growth of the total cost of care for an assigned population of patients).

The Medicare Shared Savings Program shares the savings of ACO effort between the ACO & CMS (the providers continue to receive Fee for Service payments at this time).

To earn shared savings, providers must provide detailed documentation across all four domains of quality:

1) quality standards on patient experience 2) care coordination and patient safety 3) preventive health 4) at-risk populations

Providers are eligible for the shared

savings based on how they perform in 33 quality measures in the second and third performance years.

WHY ARE ACOs IMPORTANT?

HHS estimates that ACOs could save Medicare up to $940 million in the first four years.

20% of ACOs are community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities.

25-31 million patients – roughly 10% of

the US population – are affected by an ACO in some way.

92.6% of payers report looking at ACO participation, while 91.5% of providers say they are considering participating.

WHY WOULD PHYSICIANS JOIN AN ACO?

1. Ease of Entry to Value-Based Payments Value-based payments ARE coming whether a provider joins an ACO or not. Medicare has created a roadmap for ACOs which eases the way into the value-based system without losing money or violating anti-trust laws.

2. Patient Retention & Loyalty Patient retention and loyalty is key to any provider’s success. When patients receive well-managed care and experience better outcomes, they are far more likely to stay loyal to their provider.

3. Physician-Determined Risk The Medicare incentives offer ACOs the ability to earn incentives at different levels depending on the amount of risk the organization is willing to take on.

3. Physician-Determined Risk (cont.) ACOs under the “one-sided” payment model of the Medicare Shared Savings Program are:

• Still compensated on a fee-for-service basis • Eligible for bonuses of 50% of the shared savings • Not required to assume financial risk of cost-of-care increases throughout a three-year contract period

3. Physician-Determined Risk (cont.) ACOs under another model of the Medicare Shared Savings Program are:

• Eligible for bonuses of 60% of the shared savings • Responsible for paying back government for cost overruns • Required to assume financial risk of cost-of-care increases

4. Revenue Gains CMS estimates the average ACO will recoup its expenses by a ratio of 2.9, meaning that if the ACO spends $3 million to become established and to be maintained then it should earn $5.7 million in profits.

INTERESTED IN LEARNING MORE?

LEARN MORE ABOUT ACO

ACCREDITATION:

http://www.successehs.com/item/what-is-aco-accreditation.htm