This week, the Centers for Medicare & Medicaid Services announced 2014 results for 333 Medicare Accountable Care Organizations (ACOs). It’s pretty exciting news; 56% of ACOs reduced costs and improved quality measures and reporting, which is up from 40% in previous years. The downside of the report is that only 29% of ACOs participated in shared savings, which is simply not enough. The ACOs are saving money, but they’re not earning revenue at the same rate. It’s clear that we, as in industry, have to do more to facilitate success. Think like a payer To earn shared savings, ACOs need to think more like payers. Unlike traditional fee-for-service models, new value-based-care models require providers to balance risk scores and quality measures for better patient care. They have to manage patient coding to account for risk, which is what payers do […]

In a healthcare industry that is shifting from fee-for-service to value-based-care models, it’s increasingly important for practices to understand everything about their costs. To that end, Centers for Medicare and Medicaid Services (CMS) delivers a claim file to Accountable Care Organizations (ACOs). Unfortunately, ACOs often don’t take full advantage of the intelligence available within the CMS claim file. But if ACOs can unlock these “mysteries” held within the file, they can reduce costs more quickly. Here are just a few examples: Where do all my patients receive care? Your CMS claim file can show you where your patients are actually receiving care. The answer may surprise you. For example, we helped one of our ACO clients in the rural Midwest plot on a map where its patients were receiving care. As expected, patients received a lot of care in the […]

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4 essential steps to forming an ACO

January 2016 may seem like a long ways off. But if you’re thinking about forming an Accountable Care Organization (ACO) for next year, the clock is already ticking. The fee-for-service reimbursement model is shifting to value-based-care financial models, such as an ACO. The U.S. Health and Human Services (HHS) set a goal of tying 30% of its payments to these types of arrangements by the end of 2016, and 50% by the end of 2018. Now is the time to start planning. Here’s a checklist of the essential steps organizations should take in 2015 to be ready to start an ACO in January: 1. April & May 2015 – Decide if the ACO model is the right one for you. Assess your current situation with questions like these: Are physician incomes going up or down? Are your physicians properly aligned […]

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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 […]

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 […]

How can healthcare organizations that were built on volume adapt to the arrival of a value-based reimbursement system?  To help answer that question, we’re continuing our four-part series of posts based on a new white paper by Allscripts Chief Medical Officers Doug Gentile, MD and Toby Samo, MD exploring the unique perspectives of pioneering Accountable Care Organizations. In this fourth and final part of the series, Drs. Gentile and Samo explore how ACO’s manage their relationship with patients, and conclude with some parting advice from the pioneers.  To read the white paper in its entirety, go to www.allscripts.com/ACOwhitepaper.    Patients   Key Takeaways:   Invest in the sickest Ensure social media informs physicians first Patient Mobility Improves Customer Service  For many, the Achilles’ heel of the ACO concept is consumer involvement. Healthcare is the only industry in which the consumer has an indirect […]