Georgia gets role in Medicare ‘accountable care’

Print Friendly and PDF By: Andy Miller Published: Apr 11, 2012

The federal government announced Tuesday that 27 health collaboratives –- including two in Georgia — have been picked to participate in a new Medicare program that provides financial incentives for doctors and hospitals to form an “accountable care organization.”

The program is called the Shared Savings Program. If the organizations improve patient care and contain costs, they can share in the savings, getting paid more for keeping their patients healthy and out of the hospital.

Accountable care organizations, or ACOs, are a central feature of the federal health reform law of 2010, also known as the Affordable Care Act. Medical providers will be rewarded based on the quality of care they provide, not the volume of services they deliver, as under the traditional fee-for-service model.

The U.S. Supreme Court is considering a challenge to the health care law and is expected to rule in June whether the law and the programs it has created remain in effect.

A Kaiser Health News article points out that the announcement on ACOs was the government’s first major health law action since the court held arguments on the law two weeks ago.

The 27 new ACOs will serve an estimated 375,000 beneficiaries in 18 states. The Georgia collaborations are in Athens and Savannah.
The Accountable Care Coalition of Coastal Georgia is an ACO formed in partnership between South Coast Medical Group and a local health system. It will serve about 8,000 beneficiaries in the Savannah area.

The Accountable Care Coalition of Greater Athens is an ACO established between the Coalition of Athens Area Physicians and a health system there. It is expected to serve about 8,500 beneficiaries.

The Centers for Medicare and Medicaid Services said it is reviewing another 150 applications from additional ACOs seeking to enter the program in July.

Last December, Health and Human Services picked 32 organizations — though none in Georgia — to take part in an advanced version of the Medicare program. These “pioneer’’ organizations are further along in developing the ACO model, the KHN article reported.

Together with six Physician Group Practice Transition Demonstration organizations that also started in January, the 65 ACOs will serve 1.1 million Medicare beneficiaries, CMS said in a statement.

“We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefiting millions of seniors and people with disabilities across the country,” said CMS Acting Administrator Marilyn Tavenner in a statement.

The selected ACOs include more than 10,000 physicians, 10 hospitals and 13 smaller physician-driven organizations in urban and rural areas.

Advocates say ACOs can improve care for Medicare beneficiaries and slow rising costs by changing the incentives that influence how doctors and hospitals operate. Participation is voluntary for both providers and patients.

Some ACO leaders told Kaiser Health News that they aren’t worried about the outcome of the Supreme Court case.

“It’s not changing anything for us,” said Emily Brower, an executive director with Atrius Health, operator of a pioneer ACO in Massachusetts. “This is a model of care we’ve been trying to evolve into since before the pioneer program existed.”

Here is a KHN explainer on how ACOs work.

 

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