Physician-only ACOs have been leaders in quality and achieving real savings since the inception of the Medicare Shared Savings Program, according to an AMA resource.
Here are seven things to know.
1. According to a CMS fact sheet, the number of ACOs participating in the various tracks of the MSSP increased from 480 in 2017 to 561 in 2018. Of these, 171 are physician-only ACOs, up from 134 in 2016.
2. Of the 432 MSSP ACOs operating in 2016, 31 percent generated shared savings; 45 percent of physician-only ACOs generated shared-savings, compared to 23 percent of the 226 hospital-based ACOs.
3. This year, CMS launched a new Advanced Alternative Payment Model for physicians, the Medicare ACO Track 1+. This option limits downside risk for participating practices while also allowing them to collect a lump-sum bonus that was previously available only to those who assumed more risk.
The new APM is considered friendlier to smaller practices, according to the AMA Wire. Smaller MSSP ACOs are outperforming their larger counterparts. According to CMS, however, the majority of ACO-served Medicare beneficiaries are seen by integrated health system-operated ACOs.
4. An ACO is intended to focus on aggressive intervention and better coordinated care and patient engagement to manage chronic conditions, improve wellness and limit the number of acute events. Physician-led ACOs have greater flexibility to contract with allied providers who will comply with clinical pathways, quality reporting and care coordination as they are building the ACOs network.
5. The resource identifies the Fla.-based physician-owned Palm Beach Accountable Care Organization as one of the most successful. The ACO did not try to control where its patients sought care, but instead achieved success by defining expectations and improving coordination with all stakeholders, including specialists, hospitals, home health agencies and skilled nursing facilities.
The Palm Beach ACO serves approximately 30,000 beneficiaries and achieved $22 million in shared savings in its first performance year.
6. Physician-only ACOs often face a lack of capital to support the infrastructure and investment necessary to document and implement MSSP compliance requirements, meaningfully develop better patient portals, care coordination and clinical pathways. Despite limited capital, physician-only ACOs have been able to obtain management and information technology software and to build care coordination and compliance infrastructure from third party vendors willing to accept contingency payments based on potential shared savings. Health insurers and private equity funded management companies have been active in this area.
7. To be successful, physician-only ACOs must develop relationships with allied providers to ensure proper transitions of care and to manage acuity of patients through proactive population health management.
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