Cool re­cep­tion

Few hos­pi­tals em­brace model: sur­vey

Modern Healthcare - - LATE NEWS - An­dis Robeznieks

Not many hos­pi­tals were par­tic­i­pat­ing or plan­ning to par­tic­i­pate in an ac­count­able care or­ga­ni­za­tion last year, but among those that were, physi­cians were front and cen­ter in their gov­er­nance, ac­cord­ing to a new is­sue brief from the Com­mon­wealth Fund. The Com­mon­wealth Fund re­ported that only about 13% of hos­pi­tals sur­veyed were par­tic­i­pat­ing or plan­ning to par­tic­i­pate in an ACO; 12% were un­sure; and 75% said they were not ex­plor­ing the model at all.

How­ever, the sur­vey was con­ducted be­tween May and Septem­ber of 2011, and the CMS re­leased its fi­nal rule on its Medi­care shared-sav­ings ACO model in Oc­to­ber 2011. This fi­nal rule was more warmly re­ceived by the health­care in­dus­try than was the pro­posed rule is­sued in March 2011.

In the sur­vey, 3.2% of re­spon­dents said they were par­tic­i­pat­ing in an ACO; 9.6% said they planned to do so. Of this group, 51% said they were par­tic­i­pat­ing or plan­ning to par­tic­i­pate in a physi­cian-hospi­tal joint ven­ture, and 20% said the ACO would be physi­cian-led, while 18% had hospi­tal-led gov­er­nance, and 2% were payer-led.

Providers’ swing from pes­simism to op­ti­mism on ACOs af­ter the re­lease of the CMS’ fi­nal rule was no­table, said Tom Flatt, spokesman for the Amer­i­can Med­i­cal Group As­so­ci­a­tion. “Cer­tainly, we saw a lot of that,” he said. But he added that many AMGA mem­ber or­ga­ni­za­tions were al­ready col­lab­o­rat­ing with pri­vate in­sur­ers—rather than Medi­care or Med­i­caid—on de­vel­op­ing shared-sav­ings pro­grams.

This was true also of the ACO-in­ter­ested hos­pi­tals in the sur­vey, as 56% of them re­ported ac­tively pur­su­ing ACO con­tracts with com­mer­cial pay­ers. And 32% were pur­su­ing CMS Pi­o­neer ACOs. A far smaller share— only 16.1%—said they were work­ing on a Med­i­caid ACO, and 14.9% said they were look­ing to par­tic­i­pate in the Medi­care shared-sav­ings pro­gram.

While 52.1% of the ACO-in­ter­ested hos­pi­tals were work­ing on a ba­sic shared-sav­ings pro­gram, 34.3% were de­vel­op­ing mod­els com­bin­ing shared sav­ings with shared risk. More than one-quar­ter, 27.2%, re­ported ex­plor­ing mod­els com­bin­ing global pay­ment with shared risk, and 26.8% were look­ing at par­tial cap­i­ta­tion-shared risk mod­els.

The av­er­age size of the 213 ACO-par­tic­i­pat­ing or ACO-as­pir­ing hos­pi­tals was 322 beds. In com­par­i­son, among the 1,255 hos­pi­tals not ex­plor­ing the ACO model, the av­er­age bed count was 173. In ad­di­tion, 64% of those in­ter­ested in the model were part of a health sys­tem or mul­ti­hos­pi­tal or­ga­ni­za­tion, com­pared with 47% of those in the ACO-un­in­ter­ested group.

Flatt said early adopters of the ACO model tended to be larger or­ga­ni­za­tions be­cause they have the in­fra­struc­ture re­quired to make it work. The AMGA, which has more than 400 mem­ber or­ga­ni­za­tions, was an early cham­pion of ACOs.

“These sorts of mod­els re­quire a large pri­mary-care side,” Flatt said. “They have to have a large am­bu­la­tory com­po­nent for it to be a vi­able fi­nan­cial model for any or­ga­ni­za­tion.”

The Com­mon­wealth Fund is­sue brief also noted that, as of this sum­mer, 154 groups were par­tic­i­pat­ing in CMS-spon­sored ACO ini­tia­tives.

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