Physi­cians Hope­ful over fu­ture of ACOS

Modern Healthcare - - SPECIAL REPORT -

When it comes to the pos­si­bil­ity of re­plac­ing the sus­tain­able growth-rate for­mula used to de­ter­mine physi­cian Medi­care pay­ment, 2012 might not look a lot dif­fer­ent from the past year.

Don­ald Fisher, pres­i­dent and CEO of the Amer­i­can Med­i­cal Group As­so­ci­a­tion, is as pes­simistic as ever—but he ex­pressed some op­ti­mism that a “carve-out” or “sep­a­rate bucket” could be cre­ated for Medi­care pay­ments for ac­count­able care or­ga­ni­za­tions.

“We’re prob­a­bly go­ing to see the can be kicked down the street again this year,” he says of the SGR. “I don’t see any chance of re­plac­ing or re­peal­ing it.” But, if ACOS live up to their po­ten­tial for pro­vid­ing higher-qual­ity, low­er­cost care, “there should be some recog­ni­tion,” Fisher says. The AMGA has been a cham­pion of the ACO con­cept, and Fisher says the fi­nal CMS rules on ACOS for Medi­care were a vast im­prove­ment over what was first pro­posed. So he sees mo­men­tum build­ing. “I think they took 90% of what we asked for,” Fisher says. “Now I see some ex­cite­ment.”

For 2012, Fisher says he sees fur­ther con­sol­i­da­tion or hos­pi­tal ac­qui­si­tion of physi­cian prac­tices driven in part by the need or de­sire to pool re­sources on health in­for­ma­tion tech­nol­ogy pur­chases and ad­min­is­tra­tive over­head. This con­sol­i­da­tion also will help cre­ate op­por­tu­ni­ties for bet­ter care co­or­di­na­tion and elim­i­nate vari­a­tions in care that of­fer no value to pa­tients. The trick, Fisher says, is to elim­i­nate most vari­a­tion with­out sti­fling in­no­va­tion.

Fisher says prac­tices will also be chal­lenged by the switch to the new ICD-10 di­ag­nos­tic

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