MDNews - Mid Hudson

+++++++++++++++++++++++ HEALTH MATTERS … +++++++++++++++++++++++ + + +++ +++ care needs of a minimum of 5,000 Medicare benefi ciaries for at least three years. The ACO is charged to improve the cost and quality of the care benefi ciaries receive with the incentive of sharing in the Medicare savings, which is believed to result from the ACO’s superior care. Your Piece AS A Physician’s Current Standing Health care costs have skyrocketed to 17.3% of the gross domestic product in 2009, while insurers and Medicare have sought to curb the industry’s infl ation by reducing physician fees and reimbursements. This has in turn led to a drop in the number of single or small physician groups — down 32.5% in 2008 — and the growth of physicians seeking hospital employment. Given the numbers, ACOs could offer a practice-sustaining option. Physicians can partner with insurers, hospitals, other physician practices or even form insurance co-ops consisting of multiple physician practices. The common denominator in each model’s success is the participating parties’ willingness to cede or effectively share leadership. The Proven Example The Medicare Shared Saving Program — the CMS’s vehicle for managing and potentially distributing rewards for cost saving to ACOs — conducted a three-year case study from 2005 to 2008 that demonstrated the functionality of a physician group practice model for an ACO. The study found that participating physicians in the 10 groups recommended fi nancial investment in multiple avenues to enhance quality and trim unneeded services, as well as physician leadership and interactive, data-driven health information technology. The case study also discovered that all of the physician group practices met the program’s benchmark — based on the per-benefi ciary expenditures for Part A and B services for Medicare fee-for-service fi gures over the previous three years — in 28 of 32 areas, and six out of the 10 profi ted from the $46 million in savings of the three-year study. s 18 | Mid Hudson MD NEWS  MDNEWS.COM of the Health Care Reform Puzzle THE IDEA OF AN ACCOUNTABLE CARE ORGANIZATION (ACO) COULD REVOLUTIONIZE THE INCENTIVE SYSTEM IN THE HEALTH CARE INDUSTRY. THOUGH SEVERAL QUESTIONS REMAIN REGARDING A PROPER TRANSITIONAL PERIOD AND THE POSSIBLE OVERALL SUCCESS, PHYSICIANS ARE STILL EXPLORING HOW TO BENEFIT FROM HEALTH CARE REFORM’S NEWEST PROPOSAL. LAID OUT BY the Patient Protection and Affordable Care Act and mandated by the Centers for Medicare & Medicaid Services (CMS), an ACO is a group of health care providers — any combination of insurers, hospitals or physicians — united to manage the health ACOS AND ANTITRUST LAWS WHEN IMAGINING THE medical landscape populated with multiple private practices uniting or private practices joining with hospitals to form accountable care organi- zations (ACOs), the issue of how to legally structure the new organizations is a high priority. Congress defi nes the formation of an ACO by the contracts between the joining groups, none of which represent a formal merger. ACOs can avoid antitrust laws by adhering to the guidelines for clinical and fi nancial integration. The Department of Justice and the Federal Trade Commission stress the underpinning of fi nancial integration as shared fi nancial risk. This risk serves as a motivation to collaborate to improve quality and manage costs. There are less standardized rules for clinical inte- gration. However, ACOs are encouraged to rely on the creation of an interdependent practice with control mechanisms for clinical processes, a discriminating selec- tion process for participating physicians, and a substantial amount of capital and manpower behind a continual evolution and implementation of effi ciencies.

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