JANUARY 25, 2012

Welcome to the Accountable Care Update eNewsletter
This issue is sponsored by ACO Congress


Do Medicare Demos Work? CBO Says No
Pilot programs created to study Medicare payment reform failed to produce significant savings or improve care quality, according to a Congressional Budget Office (CBO) brief. CBO researchers examined the results of 10 major demonstrations, including six that focused on disease management and care coordination and four that studied value-based payment. According to the findings, none of the demonstrations decreased spending and some actually increased costs by paying fees to participating organizations. (The Advisory Board Company, January 19, 2012)

Can Accountable-Care Organizations Improve Health Care While Reducing Costs?
It's often said that the main method of paying health-care providers -- with a fee for each service -- results in increased and wasteful spending. Such a system, its critics say, rewards providers just for doing more procedures, rather than for providing efficient and high-quality care. One major effort to fix that system, promoted by the federal health-overhaul law and some private insurers, is to create accountable-care organizations, or ACOs. (The Wall Street Journal, January 23, 2012)

Will ACOs Show Financial Returns?
Despite projected goals of saving $400 million in three years of Shared Savings and $1.1 billion in five years for the Pioneer Program, accountable care organizations (ACO) encounter skeptics on whether the financial benefits will outweigh the initial start-up costs and investments. (Fierce Healthcare, January 23, 2012)

ACO: Change Agent or Fad?
Aetna recently published results of two studies suggesting that ACOs can indeed cut Medicare enrollee costs. The results came from two medical groups - one in Ohio and one in Florida. The Florida group reduced inpatient hospital days by 37% and hospital readmissions by 27%. The Ohio group reduced inpatient days by 30% and hospital readmissions by 27%. In each case the program started in 2009 - so not bad results for a 2 year program--right? (Gorman Health Group, December 13, 2011)

Chasing Unicorns? 32 Health Systems Don't Believe So
As an author of a book focused on planning for Accountable Care Organizations, I've heard from all too many providers and consultants who believe the concept will never take off. Although I remain cautiously optimistic about this new care delivery model, I am very much looking forward to the results of the Pioneer ACO program. As you may be aware, the Pioneer ACO program is the latest initiative from CMS's Innovation Center. The goal is to assess the impact of different payment mechanisms within organizations that have already proven they can accept risk and act as an ACO. (divurgent.com, January 18, 2012)

VIDEO: Rich Umbdenstock on the Accountable Care Era
The AHA president discusses the challenges hospitals face in health care's changing world. (H&HN Daily, January 18, 2012)

Mercy Medical Center Selects MedVentive Technology to Manage Accountable Care Contracts
Mercy Medical Center, Des Moines, Iowa's longest continually operating hospital, has signed an agreement to implement MedVentive Population Manager™ and MedVentive Risk Manager™ to manage risk and quality performance as it takes on its first accountable care contract. MedVentive's technology platform will enable Mercy to transform into an accountable care organization (ACO), improve clinical outcomes and reduce variations in care, as well as capture and manage financial and utilization data. (prweb.com, January 17, 2012)

Will You or Your Group Participate in an ACO Arrangement in the Future? 5 Pain Management Physician Responses
Five pain management physicians discuss whether an accountable care organization arrangement might be in their future. They include: Laxmaiah Manchikanti, MD, Pain Management Center of Paducah (Paducah, Ky.); Frank J. E. Falco, MD, Mid Atlantic Spine (Bear, Del.); David Kloth, MD, founder, medical director and president of Connecticut Pain Care (Danbury, Conn.); R. Andrew Robertson, MD, founder and president, Wellspring Pain Solutions (Columbus, Ind.); Marc E. Lynch, DO, medical director for Casa Colina Surgery Center (Chino, Calif.). (Becker's Hospital Review, January 17, 2012)

Doctors vs. Obamacare: Can Your Physician Simply 'Opt-out'?
The destruction of quality in the American medical system will not result from one isolated event. Neither the 'Affordable Care Act', its restricted pay to physicians, nor even rationed care will immediately tip the scales toward a subpar medical system. Rather, the turn for the worse will take effect as several pieces of the Obamacare puzzle are set into motion over the next few years. (The Washington Times, January 17, 2012)

Pick Me! Hospitals & Senior Care Providers Partnering for Coordinated Care
The effects of healthcare reform will become increasingly apparent in 2012, and senior care providers may find themselves -- and their marketing strategies -- particularly impacted by Accountable Care Organizations (ACOs) as they line up to partner with hospitals and other healthcare providers. ACOs are groups of doctors, hospitals, and other healthcare providers that work together to give coordinated care to their Medicare patients to improve care quality, ensure best outcomes, and thereby reduce Medicare costs. (Senior Housing News, January 17, 2012)

NCQA Names First 6 'Early Adopter' ACOs
The National Committee for Quality Assurance (NCQA) has announced the first six provider-based accountable care organizations (ACOs) to seek accreditation from the ACO Accreditation program NCQA launched in November. The six early adopters are: Billings Clinic, Billings, Mont.; Children's Hospital of Philadelphia, Philadelphia, Pa.; Crystal Run Healthcare, Middletown, N.Y.; Essentia Health, Duluth, Minn.; HealthPartners, Minneapolis, Minn.; Kelsey-Seybold Clinic, Houston, Tex. (Healthcare IT News, January 13, 2012)

Can Participation By A Nonprofit Hospital In An ACO Trigger Unexpected Bond Consequences?
Can participation in an Accountable Care Organization (ACO) cause a nonprofit hospital's bonds to become taxable? A quick inquiry to bond counsel would probably yield an answer of "it shouldn't" in many cases. While this response would be legally sound in most instances, it is worth analyzing current bond law to make sure that the private activity bond rules are not inadvertently triggered when a nonprofit hospital (such as a governmental, public or private nonprofit hospital) and certain primary care physicians choose to participate in an ACO. (mondaq.com, January 12 - Free Subscription Required)

For Pediatric ACOs, Providers Need Not Apply
Among the myriad federal healthcare initiatives stemming from the Patient Protection and Affordable Care Act, at least one highly anticipated program has fallen through the cracks. The 2010 law authorized the creation of pediatric accountable care organizations within Medicaid. Such pilot projects were supposed to start on Jan. 1. (Modern Healthcare, January 11, 2012)

Medicare Shared Savings Program Video Slideshow Presentations and Podcasts Now Available

Do you want to learn more about the Medicare Shared Savings Program (Shared Savings Program) and how to apply? CMS has posted new resources on the Shared Savings Program CMS Teleconferences and Events webpage. (cms.gov)

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Pioneer ACO Demonstration

Mai Pham, MD
Director, Innovations Center, Centers for Medicare and Medicaid Services, Washington, DC