6 points every physician should consider about Medicare ACOs

by Asa Lockhart, MD

Doctors, that age-old business advice still applies: Take your time and read carefully, and evaluate what it might mean to your patients and your practice, before you sign a contract.

Specifically, the Patient Protection and Affordable Care Act (PPACA) paves the way for Medicare shared savings accountable care organizations (ACOs).

Conceptually, this type of ACO is a collaboration of physicians and health care providers that accepts accountability for the costs and quality of an assigned population of Medicare patients. The goal of this model is to reduce costs while improving quality by weaning physicians and providers from uncoordinated care. New and future payment models for ACOs in the commercial market may use a number of payment methods including fee-for-service payments with incentives, bundled payments, partial capitation, or some combination of payment models.

Even though the new health law is extremely murky on exactly how the Medicare shared savings ACOs work, many hospitals and physicians already are moving ahead to form collaborations.

My concern is that doctors are rushing, are being enticed, into systems that won’t protect them or their patients. I’m afraid physicians who act too early could harm their practices and patients.

Even though no one knows precisely how ACOs will work, there are a few facts we do know. For starters, the new law is clear on these features of Medicare shared savings ACOs.

1. What can you do if you disagree with the government’s decision about whether your ACO is eligible to share in any savings? Nothing. The law specifically prohibits any administrative or judicial appeals of this decision.

2. What can you do if you disagree with the amount of shared savings the government decides to pay you for your patients under an ACO? Nothing. The law specifically prohibits any administrative or judicial appeals of this decision.

3. What can you do if you disagree with the Medicare patients the government assigns to your care under an ACO? Nothing. The law specifically prohibits any administrative or judicial appeals of this decision.

4. What can you do if you disagree with the measurements the government plans to use to determine the quality of care you provide to your patients under an ACO? Nothing. The law specifically prohibits any administrative or judicial appeals of this decision.

5. What can you do if you disagree with the government’s assessment of the quality of care you are providing to your patients under an ACO? Nothing. The law specifically prohibits any administrative or judicial appeals of this decision.

6. What can you do if the government terminates the ACO from participating in the shared savings program? Nothing. The law specifically prohibits any administrative or judicial appeals of this decision.

Physicians need to be wary and be informed. Please take the time to learn about these systems, and understand their differences and what they could mean to your practice and your patients, before you sign any agreements.

Asa Lockhart is Chair, Texas Medical Associations’ Ad Hoc Committee on Accountable Care Organizations

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