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Muir Health, UCSF Medical Center expand ACO

August 1, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

Walnut Creek, Calif.-based John Muir Health and UCSF Medical Center, in San Francisco, have expanded their Accountable Care Organization to let it better compete with huge Sacramento-based Sutter Health and Oakland-based Kaiser Permanente.

John Muir and UCSF’s Bay Area Accountable Care Network started with five hospitals but has since been expanded to add seven more hospitals and three medical groups. The newly expanded ACO has been renamed Canopy Health.

The following California hospitals recently joined Canopy Health: San Ramon (Calif.) Regional Medical Center; Washington Hospital, in Fremont;  Marin General Hospital, in Greenbrae; Sonoma (Calif.) Valley Hospital;  San Leandro (Calif.) Hospital; Alameda (Calif.) Hospital, and Highland Hospital, in Oakland.

To read The San Francico Chronicle article on this move, please hit this link.

Study: Non-ACO hospitals sometimes do better than ACO ones

July 26, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

A  study in the American Journal of Managed Care indicates that hospitals that participate in an Accountable Care Organization don’t necessarily  perform better that non-ACO peers in all Medicare value-based programs.

Here are three key study findings, as summarized by Becker’s Hospital Review.

1. “Between 2013 and 2016, hospitals in ACOs performed better than non-ACO hospitals in CMS’s Hospital Readmissions Reduction Program by a factor of 0.72.

2. ”During the same period, non-ACO hospitals outperformed hospital ACOs in Hospital Value-Based Purchasing and Hospital-Acquired Condition Reduction programs by a statistical significance factor of 0.001. When researchers adjusted for specific hospital attributes, such as number of beds, ownership and teaching status, non-ACO hospitals fared better by a factor of 0.62 for the HVBP program and 0.28 for the HACR program.

3. ”’Despite similar goals, hospital participation in an ACO is not correlated with improved performance in all Medicare VBP programs,’ the study concluded.”

To read the American Journal of Managed Care study, please hit this link. To read the Becker’s summary, please this link.

N.J. ACO’s success linked to PCMHs, nurse coordination

June 23, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

 

Results have varied a lot across America for Medicare Accountable Care Organizations in their efforts to  save money and improve clinical outcomes. One that has done well is a New Jersey Medicare ACO that saved money and boosted care for two years in a row  while focusing on high-risk patients, says a study published in the American Journal of Managed Care.

The Hackensack Alliance Accountable Care Organization  had fewer readmissions and admissions and lower emergency department use, compared to a similar ACO group.  The organization also had far more patient office visits, which improved outcomes across the board, particularly for patients with chronic conditions.

The ACO reported shared savings of $5.6 million in the first year and $2.8 million in the second year.

The authors cited two big things for the successes:

  • An initial requirement that its physician practices be certified as patient-centered medical homes (PCMHs), which meant that physicians  understood what is required within a value-based care system.
  • Nurse  coordination  for patients at high risk for readmissions.

The authors of the study wrote: “We should emphasize that we do not change physician practice, we change physician behavior. By creating the appropriate interventions, we eliminate waste in our bloated healthcare system. We learn to address patient needs better. Although we are still good at disease management, we learn how to perform health management better from the PCMH model.”

To read the study, please hit this link.

ACO benchmarking issues may be fixed; next problem?

June 13, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

 

Bob Herman, writing in Modern Healthcare, reports that while CMS may have fixed its benchmarking issues with Accountable Care Organizations, that might be inadequate.

He writes: “{M}any have raised concerns that the CMS still is not doing enough to ease providers into riskier ACO models, which is paramount for Medicare’s new physician-payment system.

“The elephant in the room is not the benchmarking rule,” Clif Gaus, CEO of the National Association of ACOs, a trade group run by hospitals and physician groups, told Mr. Herman. “It is: What is CMS going to do to improve the business model for the one-sided ACOs and provide a lower-risk track for the two-sided programs?”

Hit this link to read Mr. Herman’s article.

IRS ruling whacks some ACOs

May 31, 2016by Robert Whitcomb in Uncategorized tagged , , ,

The New York Times reports that an Internal Revenue Service  ruling creates a significant obstacle to many Accountable Care Organizations. The Obama administration has promoted ACOs as a way to provide better care at lower cost.

The Times reported the  IRS  denied a tax exemption sought by an ACO that coordinates care for people with commercial insurance  since, the agency said, it  didn’t meet the test for tax-exempt status “because it was not operated exclusively for charitable purposes and it provided private benefits to some doctors in its network.”

The  name and location of the ACO,  formed by a nonprofit healthcare system, weren’t disclosed. The ruling  doesn’t affect ACOs formed solely to participate in Medicare, but it could affect similar entities serving privately insured patients, the newspaper reported. Many ACOs coordinate care for both Medicare beneficiaries and privately insured patients.

A cold look at expanding primary-care access

May 19, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

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Terence Redmond McAllister, M.D., and Leann DiDomenico McAllister push back against the idea that primary-care practices should be available to patients all the time. This leads, they argue, to clinician burnout and doesn’t help patients in the long run either.

They write:

“According to the Institute of Medicine, America’s overuse of healthcare services costs nearly $300 billion a year. And while extended and weekend hours provide ‘convenience care’ to a demanding public, extended hours have been shown to encourage patients to run to the doctor for every minor symptom they experience. Our current healthcare system trains patients to ‘feel better fast’ by running to the nearest ER with an advertised short wait time, urgent-care clinic, or buy the newest over-the-counter snake oil remedy. Contrary to popular advertising, a typical cold lasts 7 days to 10 days. It’s time we teach our patients to self-sooth.”

“Rumor has it that our quality contracts and new ACO contracts will encourage our practice to stay open longer and provide weekend hours; to be available ‘whenever’ our patients want us. We believe extended hours will increase unnecessary care which will increase costs and lead to more physician burnout.”

“Does primary care really need to be totally accessible 365 days a year, with very early and very late hours? Won’t we all sleep better and lower our burnout rate if we help our patients lower their unrealistic expectations of being ‘picked up’ {like  babies} every time they cry out?”

 

Which hospitals are in ACOs and why

March 17, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

Researchers at the The Dartmouth Institute for Health Policy and Clinical Practice have found that hospitals participating in Accountable Care Organizations tend to be large and urban.

Using data from the National Survey of Accountable Care Organizations and the Leavitt Partners ACO Database, the study, says a Dartmouth press release, “analyzed the types of hospitals participating in ACOs to determine whether they differed from those not participating. The study used interviews with key ACO personnel (predominantly chief medical officers) to examine the {characteristics} of hospital participation in ACOs.”

Among the findings:

  • “20 percent of U.S. hospitals were part of ACO in 2014.”
  • “Large hospitals rather than smaller ones were more likely to have an ACO contract. Hospitals participating in ACOs were most likely to be in the most heavily populated urban areas and least likely to be in more rural areas, with more than two-thirds  in the Eastern or Pacific  time zones.”
  • “For hospitals that participated in ACOs, 13 percent of the population in the hospital’s catchment area had incomes under the federal poverty level, compared to 16 percent for hospitals not participating in an ACO.”
  • “The large majority (85 percent of hospitals that participated in ACOs were short-term acute-care hospitals, rather than specialty or critical- access hospitals.”
  • “Teaching hospitals and those that offered a greater number of services (such as obstetrics and intensive care) were more likely to participate in ACOs, compared to non-teaching hospitals and those that offered fewer services.”

The study found these advantages of being in an ACO:

  • “Most representatives of ACOs with a hospital reported that the hospital was an advantageous source of capital to the ACO, while leaders of ACOs without hospitals thought a hospital would be a useful source of capital.”
  • “Other strategic advantages of hospital participation in an ACO included patient data sharing between inpatient and outpatient settings, such as discharge summaries or alerts to an emergency admission, as well as the ability to align financial incentives across care settings to regulate costs and ensure quality.”

The study’s authors conclude, the press release said, that “policymakers have the ability to negate some of the perceived disadvantages of forming an ACO without a hospital by providing access to capital and support for implementing health information exchange systems. They also note that for ACOs to meet quality and cost goals it will be ‘important to ensure broader and more consistent participation of different types of providers in the model.”

Blue Cross, Lifespan and physicians group form ACO

March 4, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

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Blue Cross & Blue Shield of Rhode Island’s headquarters, in downtown Providence.

Three  Rhode Island healthcare organizations, Blue Cross & Blue Shield of Rhode Island, Lifespan, a large hospital system, and Coastal Medical, a physicians group, have created an Accountable Care Organization to serve  45,000 patients.

The agreement aims to  improve how primary, specialty and inpatient care are delivered in the tiny but densely populated state.

The Providence Business News reports: “The pact offers incentives that reward enhanced care management and more efficient delivery of care for the 45,000 Blue Cross members who receive their primary care from Coastal Medical providers. The effort is expected to result in better health outcomes, lower costs and better service to patients, according to the deal participants.”

The paper said: “Blue Cross, Coastal and Lifespan will remain fully independent under this agreement, but each will work with the others in a more aligned fashion than ever before.”

HHS completes ACO waivers to avoid Stark law issues

October 29, 2015by Robert Whitcomb in Uncategorized tagged ,

 

The U.S. Department of Health & Human Services has finally completed waivers for Medicare Accountable Care Organizations to help participants avoid running int0 the fraud and abuse laws that govern financial relationships among physicians and hospitals.

Modern Healthcare reports that “The new rule makes some tweaks but doesn’t significantly change waivers to the anti-kickback statute, the physician self-referral statute known as the Stark law and the civil monetary penalties law, which many in the industry viewed as potential barriers to the payment and delivery model. The CMS and HHS’s Office of Inspector General created the waivers with an interim final rule in 2011. ”

“The fact that they have finalized it and not felt compelled to narrow it in any fashion is a really important thing,” Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh, told the publication “The federal fraud and abuse laws really do create a pretty significant barrier to a lot of the kinds of payment reform efforts that people are talking about.”

 

 

“The problem becomes if you want hospitals and physicians working together without consolidating, technically, that can be illegal today, and this enables them to do it if they’re part of an ACO but not if they’re outside of an ACO,” Miller said of the waivers. “You’ve got kind of this big gap that exists.”

No more low-hanging fruit?

May 4, 2015by Robert Whitcomb in Uncategorized tagged , ,

low-hanginhg fruit

A JAMA study has found that a federal test program that stems from the Affordable Care Act involving physicians and hospitals slowed healthcare spending in Medicare coverage by hundreds of millions of dollars in 2012 and 2013 but savings were less in the second year.

Reuters reported that the study looked at beneficiaries in 32 Pioneer Accountable Care Organizations (ACOs), in which hospitals and physicians follow 33 quality and care standards for Medicare fee-for-service patients. In return they can receive part of any healthcare savings back from the government.

The savings were 4 percent in the first year but less than 1.5 percent in the second, compared with spending on beneficiaries in traditional Medicare fee-for-service.

The big question is, of course, whether it will much tougher to get hefty new savings over the next few years or whether new systems  and processes (including new technology) will make further efficiencies when those systems are fully integrated. Were the first-year savings simply low-hanging fruit?

New ACO incentive systems are in the pipeline.

One would suspect that some folks at JAMA might not like ACO’s at all because they would tend to reduce the revenues of physicians who have prospered greatly in the fee-for-service system now  under attack by private- and public-sector payers.

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