ACOs Present HM Risk/Reward Opportunity


As the healthcare industry digests the Centers for Medicare & Medicaid Services’ (CMS) proposed regulations on accountable care organizations (ACOs), a leading hospitalist wants to ensure that physicians are duly compensated for risk in the process.

An ACO is a type of healthcare delivery model being piloted by CMS in which a group of providers band together to coordinate the care of beneficiaries. Reimbursement is shared by the group and is tied to the quality of care provided.

Under rules released March 31 and published in the Federal Register (PDF) last week, ACOs can enter a shared savings or a shared savings/losses model. According to Becker's Hospital Review, in the shared savings model, also called a "one-sided model," an ACO that creates at least 2% savings is then entitled to 50% of the revenue above that amount. The shared savings/losses construct, known as a "two-sided model," entitles an ACO to 60% of the threshold, but also penalizes them if the model increase costs, the review says.

"You can certainly start by taking a lower amount of risk, just upside risk," says Ron Greeno, MD, FCCP, SFHM, chief medical officer for Brentwood, Tenn.-based Cogent Healthcare and a senior member of SHM's Public Policy Committee. "But your plan should be not to stay there. Your plan should be to take more and more risk as soon as you can, as soon as you're capable."

By the third year of the program, all ACOs would become responsible for losses.

"I didn't see a lot with capitated risk," Dr. Greeno says. "That's where the opportunity is for providers. That's the opportunity to create the most savings in Medicare."

CMS will take comments on the proposed regulations until the first week of June. The program is set to go live Jan. 1, 2012.

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