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Physi­cians take the lead in the next phase of Medi­care ac­count­able-care or­ga­ni­za­tion con­tract­ing pro­gram

Medi­care is ex­pand­ing and di­ver­si­fy­ing its ex­per­i­ment with ac­count­able care. The lat­est crop of hos­pi­tals, med­i­cal groups and clin­ics that agreed to try out the pay­ment model known as ac­count­able care—the third group to date—was dom­i­nated by doc­tors with­out any for­mal ties to hos­pi­tals, some with as few as 30 to 50 physi­cians. That’s in con­trast to early par­tic­i­pants in dif­fer­ent pro­grams, an­nounced late last year, which in­cluded prom­i­nent health sys­tems and ma­jor med­i­cal groups such as Geisinger Health Sys­tem and Monarch Health­care.

Lead­ers at ACOS owned and op­er­ated solely by doc­tors said they nonethe­less ex­pect aid from hos­pi­tals in ef­forts to im­prove qual­ity and curb costs thanks to ex­ist­ing re­la­tion­ships and pres­sure for hos­pi­tals to re­duce avoid­able read­mis­sions.

“There were some peo­ple who feared that the only en­ti­ties that would par­tic­i­pate would be hospi­tal-dom­i­nated sys­tems,” Jonathan Blum, di­rec­tor of the Cen­ter for Medi­care Man­age­ment at the CMS, said in a call with re­porters as the new ac­count­able care groups were an­nounced. “That has not hap­pened.”

Also unique to the most re­cent slate of ACOS: one-third of them en­tered into joint ven­tures with a pub­licly traded in­sur­ance com­pany.

With 27 ac­count­able care or­ga­ni­za­tions named last week, the to­tal num­ber of such net­works un­der Medi­care has grown to 65. The newly named ACOS in­clude more than 10,000 physi­cians, 10 hos­pi­tals and 13 smaller physi­cian-led en­ti­ties.

Un­der ac­count­able care, Medi­care of­fers providers fi­nan­cial in­cen­tives—pos­si­ble bonuses, and in some cases penal­ties—to im­prove qual­ity and con­trol costs for a se­lect group of pa­tients.

Fifty or­ga­ni­za­tions ap­plied to Medi­care’s most ac­ces­si­ble ACO ef­fort, for­mally known as the Shared Sav­ings Pro­gram. Three were de­nied as un­pre­pared, Blum said in an in­ter­view. Twenty de­cided to with­draw and re­sub­mit ap­pli­ca­tions at a later date. Blum called it un­sur­pris­ing that more or­ga­ni­za­tions would ap­ply for the later start date,

Dr. Alexan­der Per­rian of New Pue­blo Medicine hugs a pa­tient. For the seven-doc­tor prac­tice par­tic­i­pat­ing in a new Medi­care ACO, bonus pay-for-per­for­mance mea­sures from pri­vate in­sur­ers have helped off­set in­vest­ment costs.

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