South Florida Hospital News
Friday August 23, 2019
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August 2014 - Volume 11 - Issue 2

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Accountable Care Options Transforms Practices to Meet Medicare Shared Savings Goal

As part of the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services instituted the Medicare Shared Savings Program as a way to facilitate coordination and cooperation among providers to improve the quality of care for Medicare beneficiaries, and reduce the growth in costs. In turn, Accountable Care Organizations (ACOs) that are able to show that they have lowered health care costs while meeting standards for quality care are eligible to share with Medicare up to 50 percent of the savings that are generated.
 
Accountable Care Options, LLC, located in Boynton Beach, FL, is one of 29 ACOs that has successfully met this goal out of the 114 ACOs that started with the program in 2012. In addition to earning a quality score of 100 percent from CMS, Accountable Care Options succeeded in saving the Medicare program 11 percent in program expenditures on assigned beneficiaries—a savings of more than $1,400 per person. As a result, the company received an Interim Shared Savings check of $4.2 million, which equated to an average payment of $150,000 per practice, or $500 per Medicare fee-for-service patient. This was in addition to its regular Medicare payments.
 
“While many practices focused on very high-end technology, we focused instead on practice transformation,” explained CEO Richard Lucibella, MHS, MBA. “We looked at changing behaviors rather than technology.”
 
To this end, Accountable Care Options worked hand-in-hand with its physician partners to rebuild the relationship between primary care physicians (PCPs) and patients. “A lot of patients self-refer, which means they only see their PCPs for episodic care,” explained Lucibella. “They don’t realize that they could also be working with their PCPs for care of chronic conditions including congestive heart failure, COPD and diabetes.
 
“Often patients go to specialists because they don’t feel that they get enough time with their PCPs,” he continued. “While from a technical standpoint, they do get enough time, they don’t leave feeling like they’ve gotten a clear explanation of what’s going on and what needs to happen next.”
 
Accountable Care Options works to build ‘care teams’ to help ease any uncertainty that a patient may feel. These can include medical assistants and nurse practitioners trained to walk patients through the ins and outs of their diagnoses, as well as supplemental material, like American Medical Association videos that can be watched in the doctors’ offices. “We want to refocus the primary care physician’s office as the patient’s medical home,” said Lucibella. “The better educated the patient, the more compliant the patient, the better the outcome.”
 
Accountable Care Options also works with specialists to make sure that diagnostic tests already performed on patients are not duplicated, and that all medications are reported back to a patient’s PCP to lessen the chance of duplicated or contraindicated prescription medicines. On the preventative side, patients are encouraged to visit their PCP for an annual wellness visit, paid for by Medicare, so that physicians can set up a patient care plan for the entire year. Patient records and claims are also reviewed to make sure that patients are receiving the screenings that they need at the recommended times.
 
“It used to be that the PCP looked at the patient as a whole every time he or she came in, but that went away when third-party insurers came in with fee-for-service plans,” said Lucibella. “Now we’ve come full circle to pay-for-performance plans, which have created the opportunity to rebuild the patient/physician relationship, which results in higher quality, lower cost care.”
For more information on Accountable Care Options, call (561) 200-0325 or visit www.aco-fl.com.
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