Physicians to Lead ACOs, AMA Says

More details are forthcoming regarding ACO establishment and leadership. One of the key announcements is that 27 of the leaders of ACOs will be physician leaders. AMA Medical News announced that “Thousands of physicians will be among those coordinating patient care in the 27 accountable care organizations that were chosen in April to participate in the new Medicare shared savings payment model.”

Organized medicine was pleased to see that 21 of the 27 ACOs would be physician-run. The American Medical Association also noted that five of the approved groups will participate under an advance payment model, which provides up-front funding from Medicare to cover the costs of establishing the infrastructure needed to coordinate patient care. Advance payments make it possible for smaller groups of doctors to participate in the program in a leadership role, said AMA President Peter W. Carmel, MD. More than 50 organizations have applied for the advance payment option beginning July 1.

So far, CMS has received more than 150 applications seeking approval to participate in the second phase of the program, and the agency will announce the groups that qualify in July. Another round of applicants will be approved in January 2013.

The newest organizations to be chosen, which involve more than 10,000 physicians, have agreed to coordinate care for nearly 375,000 Medicare beneficiaries, the agency said during an April 10 briefing with reporters.

Safeguards are being put in place to insure equality with physician leadership and control

Plymouth Bay Medical Associates, Jordan Physician Associates and a number of specialty physicians from Jordan Hospital joined to form Jordan Community ACO in Plymouth, Mass. Physicians in the network will coordinate care for more than 6,000 Medicare patients.

The Vitruvian Man,  Leonardo Davinci, circa 1478 (Wikipedia)

The ACO is structured so that physicians and the hospital have an equal say in how the organization will operate and share in any savings. The pool of doctors, who mostly are primary care physicians, and the hospital each have one vote, and a majority is needed to move forward. That effectively means decisions must be unanimous or both sides continue negotiating.

This is unchartered ground so far, and the ACO will be looking for Medicare patients to be active rather than passive participants in the care model. “Patient education is paramount for any project to work,” Dr. Johnson said.

Accountable care organizations that provide higher-quality care and cut costs can earn bonuses from Medicare. Groups will be evaluated by their performance on 33 quality measures, their use of preventive health services and whether they improve care for at-risk patients. The 27 ACOs participating in the systemwide shared savings program as of April 1 will be joined by additional members in July.

But beneficiaries still retain the right to choose physicians outside an ACO.

Physician-led ACOs

• Accountable Care Coalition of Caldwell County, Lenoir, N.C.
• Accountable Care Coalition of Coastal Georgia, Ormond, Fla.
• Accountable Care Coalition of Eastern North Carolina, New Bern, N.C.
• Accountable Care Coalition of Greater Athens, Ga.
• Accountable Care Coalition of Mount Kisco, N.Y.
• Accountable Care Coalition of the Mississippi Gulf Coast, Clearwater, Fla.
• Accountable Care Coalition of the North Country, Canton, N.Y.
• Accountable Care Coalition of Southeast Wisconsin, Milwaukee.
• Accountable Care Coalition of Texas, Houston
• AppleCare Medical ACO, Buena Park, Calif.
• Chinese Community Accountable Care Organization, New York.
• Coastal Carolina Quality Care, New Bern, N.C.*
• Crystal Run Healthcare, Middletown, N.Y.
• Florida Physicians Trust, Winter Park, Fla.
• Jackson Purchase Medical Associates, Paducah, Ky.*
• Optimus Healthcare Partners, Summit, N.J.
• Physicians of Cape Cod ACO, Hyannis, Mass.
• Premier ACO Physician Network, Lakewood, Calif.
• Primary Partners, Clermont, Fla.*
• RGV ACO Health Providers, Donna, Texas*
• West Florida ACO, Trinity, Fla.

Nonphysician-led ACOs

• AHS ACO, Morristown, N.J.
• Arizona Connected Care, Tucson, Ariz.
• CIPA Western New York IPA, doing business as Catholic Medical Partners, Buffalo, N.Y.
• Hackensack Physician-Hospital Alliance ACO, Hackensack, N.J.
• Jordan Community ACO, Plymouth, Mass.
• North Country ACO, Littleton, N.H.*

*  These ACOs are receiving advance Medicare implementation funding.

Source: “First Accountable Care Organizations under the Medicare Shared Savings Program,” Centers for Medicare & Medicaid Services, April (cms.gov/apps/media/press/factsheet.asp)