Are you 65 or already on Medicare? If so, a new patient care delivery system is making its way around the country: Medicare Shared Savings accountable care organizations. The 2010 Patient Protection and Affordable Care Act did not mandate them, but encouraged their creation.
Sole practitioners, small- and mid-sized physician practices, specialty groups and other healthcare-related providers can join ranks to coordinate patient care with each other and provide the best outcome for the patient by operating as a team, rather than in “silos.” To become an accountable care organization, the combined medical group must have a minimum of 5,000 Medicare patients.
For the Medicare recipient, belonging to a Shared Savings Program ACO means having a variety of doctors and specialists working together to insure the best outcome for the patient.
For the government”™s Center for Medicare and Medicaid Services, it means Medicare dollars managed more effectively, with the goal of keeping the program financially healthy.
To date, 29 organizations in the U.S. have become accredited as Medicare Shared Savings Program ACOs. While many have forged alliances with others, Crystal Run Healthcare, headquartered in Middletown, already had the required number of patients to apply for the status without going outside its own organization. It officially became an ACO as of April 1.
Drs. Jonathan Nasser and Scott Hines, co-chief clinical transformation officers at CRHC, said Medicare monitors monthly the benchmarks it set, and there is detailed year-end accountability for every ACO participating in its program.
“Eventually, as the concept catches on with America”™s changing healthcare system, CMS expects to see a reduction in recordkeeping, since a Medicare patient”™s medical history will be combined and available in one place,” said Nasser. “Rather than trying to discern who did what, when and where, attending physicians and therapists will have the health of the patient at the forefront.
“Improving the patient”™s care, improving their experience with the quality of care they are receiving and improving the cost of that care — commonly called ”˜the triple aim”™””is what Crystal Run Healthcare is agreeing to take responsibility for,” Nasser said.
Hines stressed that the program is designed to reduce waste in the health care system. By saving money and increasing patient satisfaction with their care, Medicare ACO”™s benefit by receiving a portion of the savings.
“Part of the challenge is to help patients understand what it means if they are part of a Medicare ACO,” said Nasser. “Nothing will change for them — the way they will interact with our physicians will be no different. But we will change: We are mandated to demonstrate we are meeting the 32 quality measures CMS has set for us.” Patients in a Medicare ACO are not penalized for going to another doctor who accepts Medicare but is not part of the ACO. “Patients have the right to go where they want,” said Hines “That right is not taken away from them.”
Although Crystal Run”™s mission was already in line with the goals of the Medicare Shared Savings Program, said Nasser, “One of the criticisms of the ACO in general is the cost to implement it ”¦ in the long run, however, it will provide better care for patients and stop unnecessary spending. That is the goal.”
In CHRC”™s case, its added cost will come from adding staff — nurse “care managers,” whose job will be to stay in contact with the highest-risk patients and keep them healthier, thereby avoiding unnecessary hospital admissions.
