QCMS Creates Largest Accountable Care Organization

The Medical Society of the County of Queens has announced that it is creating one of the largest Physician Accountable Care Organizations (“ACO”) in New York. The ACO, with nearly 700 physician members, will be owned, comprised of and managed by physicians based in Queens. Authorized under the recent Federal healthcare reform legislation, the ACO will ultimately provide better and more efficient care to patients at a reduced cost.

http://www.qgazette.com/news/2010-10-27/Features/QCMS_Creates_Largest_Accountable_Care_Organization.html

While Health Reform Faces Challenge, Repeal of ACOs Unlikely

While ascendant GOP lawmakers and some 30 lawsuits seek to repeal the healthcare reform law, these efforts should not affect accountable care organizations, which are part of the law, according to speakers at the National Accountable Care Organization Congress in Los Angeles.

http://www.beckershospitalreview.com/hospital-physician-relationships/while-health-reform-faces-challenge-repeal-of-acos-unlikely.html

JOHNSON: Patient beware of accountable care organization

ANALYSIS/OPINION:
There is much to dislike about this year's massive federal overhaul of the nation's health care system. One of Obamacare's potentially most dangerous — and least discussed — features is its call for government-sponsored accountable care organizations (ACOs).

http://www.washingtontimes.com/news/2010/oct/27/patient-beware-of-accountable-care-organization/

Killing Marcus Welby

If ObamaCare really called for the creation of "death panels," the first victim of these in vented tribunals would have been Marcus Welby MD, the character in the hit 1960s television show that followed the daily dramas of a small-town family doctor. Read more: http://www.nypost.com/p/news/opinion/opedcolumnists/killing_marcus_welby_FLnABqCKwpyF9j2i9YYpCP#ixzz137PaapNg

5 Key Questions on How ACOs Will Function: From Robert Betka at Catalyst Management Advisors

The transition to accountable care organizations and shared savings is looking to be as dramatic as hospitals' shift to DRGs in the early 1980s, says Robert Betka Jr., a consultant with Catalyst Management Advisors in Grand Rapids, Mich. "This is a very exciting time," he says, noting federal authorities, private payors and ultimately ACOs themselves will have to answer some key questions on how the new system will operate. Here are five such questions.

1. How will the ACO be governed? A governing board made up of representatives from each partner would run the ACO. Would seats on the board be distributed based on each partner's significance in the organization? And how would the board interact with the governing boards of each component organization?

2. How does the ACO divide up payments? Initially, each component of the ACO would be paid on a fee-for-service basis and then would share a certain amount of the savings created by the ACO. How would that payment be divided? To determine this, Mr. Betka thinks clinical representatives from each component would have to identify the whole continuum of care for each condition and assign a value for each step in the continuum. For example, bypass surgery would involve surgery, imaging, nursing, rehabilitation and other services, depending on a variety of circumstances. While initially only the shared savings would be apportioned this way, eventually the whole payment would be broken down, Mr. Betka believes. The goal is to pay the ACO one lump sum for the entire episode of care, like a bundled payment, he says.

3. What would be the payment for prevention? ACOs with lower rates of expensive procedures would reward the specific caregivers responsible for this improvement. Mr. Betka this would often involve focusing on what did not occur, such as fewer surgeries due to better preventive care. For example, the shared savings for a lower rate of bypass operations might be apportioned to primary care physicians, cardiologists, dieticians and others who prevented a bypass operation from happening, he says.

4. How would accountability be identified? If there were an inappropriate readmission or a quality problem, would the ACO identify what component was responsible and assign the penalty to that component?

5. What is the role of healthcare IT? Making determinations on how to divide up payments, assign accountability and make care more efficient and safe would require very sophisticated healthcare IT. Computer systems would need to implement cost accounting, identifying the components of patient care and provide decision-support tools to analyze trends. However, only 7 percent of hospitals now have comprehensive electronic medical record systems.

Southeastern Wisconsin Health System, IPA Launch Accountable Care Organization

Southeastern Wisconsin's ProHealth Care and the local independent physician association Waukesha (Wis.) Elmbrook Health Care have formed the first accountable care organization in southeast Wisconsin, according to a Business Journal report.

The ACO will be launched in Jan. 2011 and will be called ProHealth Solutions. It is designed to participate in Medicare's new Shared Saving Program under the Patient Protection and Affordable Care Act.

The ACO will be a virtual community with one electronic medical record, and will include a comprehensive quality improvement program with technology that measures specific clinical and efficiency outcomes for each physician. Read the Business Journal report on southeastern Wisconsin's first ACO.

Understanding Accountable Care Organizations

By John D. Cacciamani, Jr., MD, MBA

I find that my physician colleagues, many of whom are busy with everyday caring for their patients, need some explanation when it comes to understanding Accountable Care Organizations [ACOs]. There is not now a unified definition for an ACO, but one is starting to take shape.

ACOs are healthcare delivery models composed of groups of providers responsible for managing a defined population of patients. These ACOs will be accountable for the quality and cost of care delivered to that population and will also need to distribute dollars equally across these providers.

http://www.physiciansnews.com/2010/10/13/understanding-accountable-care-organizations/

Don Berwick Comments on Goals for ACOs and Role of Federal Oversight

Kicking off a day-long federal listening session with stakeholders, CMS Administrator Don Berwick, MD, outlined his concept of the accountable care organization and how federal agencies should oversee ACOs.

He said federal regulators tailoring antitrust and fraud and abuse laws to accommodate ACOs have a fine line to walk. The legal goals for ACOs should be "cooperation without corruption, aggregation without hegemony and synergy without collusion," he said. In return, ACOs need "clarity and predictability about the regulatory regime."

http://www.beckershospitalreview.com/hospital-physician-relationships/don-berwick-comments-on-goals-for-acos-and-role-of-federal-oversight.html?sms_ss=linkedin&at_xt=4cb86983d1ac3fa8,0&goback=%2Egde_35964_member_32366730

Beaumont to lay off up to 50 managers and administrators

Beaumont Hospitals is laying off 40 to 50 administrators and managers, a move that comes as some 17,400 employees — including those being laid off — just received bonus checks.


The three-hospital system expects to wrap up the layoffs by year’s end as part of a reorganization triggered by health care reform. The layoffs, announced in an Oct. 4 newsletter, will save Beaumont $3 million to $4 million a year, said Colette Stimmell, a Beaumont spokeswoman. From The Detroit News: http://www.detnews.com/article/20101012/BIZ/10120326/1001#ixzz12AGUAfSl

Community Health Systems Affiliate Acquires Home Health Company

An affiliate of Franklin-Tenn.-based Community Health Systems has acquired Lakeland, Fla.-based Advantage Home Health Services, according to a Ledger report.

The company has been renamed Florida's Choice Home Care. It provides home health services to patients in four Florida counties, according to the report.

The move may signal efforts by Community Health Systems to align with post-acute-care providers as payments systems move to include these services either as part of accountable care organizations or in bundled pricing arrangements.

http://www.beckershospitalreview.com/hospital-physician-relationships/community-health-systems-affiliate-acquires-home-health-company.html

Research and Markets: The Colorado Accountable Care Collaborative: Practical Lessons from an ACO

With a January 2011 go-live date for an accountable care organization pilot, the Colorado Department of Health Care Policy and Financing is entering into the final stages of an RFP process to identify regional organizations that will function as ACOs, the medical homes that will serve as providers within the ACO and a state-wide data and analytics vendor that will provide real-time data to the providers within the ACO.Read more: http://www.bradenton.com/2010/10/11/2645135/research-and-markets-the-colorado.html#ixzz12ADXfuZk

St. Joseph Mercy Health System to acquire IHA physicians organization

St. Joseph Mercy Health System in Ann Arbor has agreed to acquire IHA, an Ann Arbor-based physician organization with more than 150 physicians and 37 nurse practitioners for an unspecified amount.

Over the last year, St. Joseph Mercy has been restructuring its operations within its seven hospitals in Southeast Michigan to reduce costs and prepare for changes under health care reform, said Rob Casalou, CEO of St. Joseph Mercy hospitals in Ann Arbor, Saline and Howell in an interview with Crain's today.

http://www.crainsdetroit.com/article/20101005/FREE/101009942#

7 Steps Hospitals Must Take to Embrace ACOs: From Kevin Brennan at Geisinger Health System

Geisinger Health System, an integrated network in Danville, Pa., served as one of the models for the new accountable care organization. The system participated in CMS' seminal Medicare Group Practice Demonstration, a precursor of the ACO, and recently CMS tapped Richard Gilfillan, the head of the Geisinger Health Plan, to run its Innovation Center, which is overseeing ACOs. Here Kevin Brennan, Geisinger's CFO, discusses seven steps hospitals can take to embrace the new era of accountable care.

http://www.beckershospitalreview.com/hospital-physician-relationships/7-steps-hospitals-must-take-to-embrace-acos-from-kevin-brennan-at-geisinger-health-system.html

Why Hospitals Are Beating the Bushes for Primary-Care Doctors

Hospitals are again snapping up primary care physicians as they prepare to become accountable care organizations (ACOs), says Becker’s Hospital Review. To qualify for Medicare’s future shared-savings program, ACOs must include a strong primary-care component, so PCPs are essential to this strategy. The result will be to drive more primary-care doctors into hospitals’ arms in search of higher pay than they can earn in private practice. And that adds to the evidence that the days of small independent practices are numbered.

http://www.bnet.com/blog/healthcare-business/why-hospitals-are-beating-the-bushes-for-primary-care-doctors/1846

Health Care Providers, Insurers Raise Questions, Concerns About ACOs

Physicians and hospitals are raising concerns that forming accountable care organizations, as promoted under the federal health reform law, might breach antitrust and anti-fraud laws, Kaiser Health News reports. Meanwhile, insurers are worried that ACOs could increase the cost of medical care.

Read more: http://www.californiahealthline.org/articles/2010/10/5/health-care-providers-insurers-raise-questions-concerns-about-acos.aspx#ixzz129zpWhpq

ACOs good idea; doctor support will be critical

By Don Ammon
Former CEO, Adventist Health System West

In the early ‘70s, ‘80s and ‘90s we worked on a concept similar to accountable care organizations (ACOs) in California. We tried to establish a program that would cover risk for our patients’ care with a lot of enthusiasm and effort. But unfortunately, we had very little success. It was just so complicated and expensive to get the idea off the ground.

http://actionforbetterhealthcare.com/?p=1270

ACOs May Cause Healthcare Cost Inflation Rather than Savings

Rather than save money, some experts argue accountable care organizations will further inflate prices, as hospitals unite with physicians and other providers against private insurers, according to a report by the Washington Post.

In an article on the effect of hospital mergers on healthcare inflation, the Post referred to a study in the February issue of Health Affairs examining an alliance in California similar to an ACO. The study concluded that if ACOs are able to exert more market power in negotiations, "private insurers could wind up paying more, even if care is delivered more efficiently."

http://www.beckershospitalreview.com/hospital-physician-relationships/acos-may-cause-healthcare-cost-inflation-rather-than-savings.html

AHA Shows How 4 Key Federal Enforcement Laws Impair ACOs

Four major federal enforcement laws, from the antitrust law to the anti-kickback law, will impede efforts by hospitals and other providers to create accountable care organizations, the AHA stated in a letter to CMS, the Federal Trade Commission and the HHS Inspector General.

http://www.beckershospitalreview.com/news-analysis/aha-shows-how-4-key-federal-enforcement-laws-impair-acos.html

ACOs: Danger lurks in health-care reform

Not many people outside of the health care world know what an Accountable Care Organization (ACO) is, or what it is supposed to do. Frankly, most health care insiders don’t know what an ACO is. The fact is that ACOs are an amorphous attempt to change the way health care is delivered and paid for and its implications are massive.

http://www.capitolweekly.net/article.php?_c=z62mjyg1hxl8cy&xid=z62a6g3jelt1zt&done=.z62mjyg1hya8cy