An ACO rookie’s most common mistake

To stay competitive in an evolving healthcare landscape, independent small physician practices are creating their own Accountable Care Organizations (ACO). It’s important for them to have accurate expectations before applying to Center for Medicare & Medicaid Services (CMS) and its Shared Savings Program. Unfortunately, new ACO applicants often miscalculate the number of CMS patients, or “attributed lives,” they are responsible for, putting their entire cost structure at risk. Whose patient is it? CMS assigns each patient to a provider who will be responsible for that patient’s cost and quality of care. A sophisticated algorithm determines where this patient belongs, based on claims data. A smaller primary practice may assume that every History and Physical (H&P) it performs for Medicare patients will count toward its attributed lives total, when in fact that is not the case. For example, if that patient […]


Finding tomorrow’s high-risk patients

As the healthcare industry offers more ways to earn risk-based or value-based revenue, providers are more proactively coordinating care, engaging patients and managing population health. Analytics are fundamental to all of these strategies, even in small practices. To be successful, physician practices need analytics that are predictive across multiple populations. They need to know who the high-risk patients are today, but they also need to identify the “rising-risk” patients. With intervention, these patients can have a healthier future. The cost of unmanaged cardiac conditions One healthcare organization evaluated its Accountable Care Organization (ACO) population with Johns Hopkins Adjusted Clinical Groups (ACG®), an industry standard to adjust risk and predict future healthcare usage. With analytics, this ACO found that more than half of its patients were either high risk (30%) or very high risk (27%). Furthermore, it found that the average […]

According to recent quality reports of 220 Accountable Care Organizations participating in the Medicare Shared Savings Program (MSSP), Coastal Carolina Quality Care ranked third overall and second in care coordination. This ACO and its associated physician practice, Coastal Carolina Health Care (CCHC), use Allscripts TouchWorks® EHR and FollowMyHealth®. We recently interviewed CCHC Chief Executive Officer Stephen Nuckolls and Associate Administrator Carrie Hagan about their success with MSSP and the Meaningful Use incentive program. For 2014 four providers attested for Stage 1, and 38 providers attested for Stage 2. What’s the secret to their success? Nuckolls and Hagan share these six tips for achieving Meaningful Use Stage 2: 1. Allow plenty of time Carrie Hagan: “We started the implementation process back in November of 2013, working towards attesting in the second quarter of 2014…We wanted that intense focus for a longer […]

Craig Dreher, chief information officer at Mercy Health System (Portland, ME, U.S.A.), recently observed, “In the Accountable Care Organization (ACO) environment, you have to do everything exactly right. You get paid only if you meet certain measurements. Can you imagine applying those standards in other places, like the airline industry?” That’s an interesting thought. Instead of a set price in advance for each flight, what if airlines could only receive payment upon meeting certain measurements? The flight must take off and land on time. Gauges must prove that the plane used correct amounts of fuel and oil. The pilot reports in a timely and precise manner to air traffic control. This is what is being asked of medicine. What if consumer behavior also contributed to whether or not airlines receive payment? All passengers must stow their carry-on baggage safely and […]