ACO Quality Results

ACO Quality Results

CMS also released ACO-level performance on all 33 measures for Pioneer participants in year one and year two. The 23 ACOs that remain in the Pioneer Program showed overall improvement in average quality scores from the first to second performance year. The ACOs also improved overall on 28 of 33 measures

More emphasis to be placed on the ACO Models.

Are you understanding  Quality instead of Quantity ?

ACK  offers various alternative to help you decide if an MSO or ACO is an option for you.  Are you at RISK with the HMO / Managed Care ?  Understanding the various quality measures a concern to you?

• MCARE Reports -  define where the expenses are and what actions to take

• ACO depend on the reports to maintain Cost down.

• Support is the Key Issue to navigating in today’s healthcare system.

For details call : 305-227-2383  or 1-877-938-9311

ACK Support :

ACK Hotline is your solution for your Medical Reimbursement.  A support service that will assist you with:

PQRS                                                                HEDIS

National Quality Measures                          ICD-10

Coding                                                             Meaningful Use

Value-Based Modifier                                  MRA

 How It Works:

•             Unlimited Email Support

•             Unlimited Calls

•             No Contracts ~ Cancel When You Want

•             $59.00 per Month

•             Service is:  Monday through Thursday  8:00AM to 5:00PM

                                   Friday 8:00AM to 1:00PM

 

Avoid the penalties and understand how to navigate in today’s medical reimbursement !!! 

 

 For More Details: 305-227-2383  or 1-877-938-9311 ( Ask For Felicia )

ACO Status Update

A pilot program created under ObamaCare to change Medicare’s payment system saved almost $400 million and will be expanded, the administration announced Monday. 

An independent report released by the Department of Health and Human Services on Monday finds that the pilot program saved Medicare more than $384 million across 2012 and 2013.

The pilot program, called Pioneer Accountable Care Organizations, is part of an effort to shift Medicare to paying for quality instead of quantity of care.  

Under the program, groups of doctors agree to accept lump payments under Medicare instead of individual payments for each service they provide, as in the traditional Medicare payment system.

 The idea is to discourage unnecessary tests and procedures and better coordinate care. If the groups of doctors, known as Accountable Care Organizations (ACOs), end up keeping costs below the target, they get to keep some of the leftover money, providing an incentive to keep costs down. 

   

The Obama administration is touting the pilot program, claiming it's paid off and generated savings.

 “The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier,” HHS Secretary Sylvia Mathews Burwell said in a statement. “The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.” 

The independent Office of the Actuary of the Centers for Medicare and Medicaid Services (CMS) has now certified that the program can be expanded. It currently applies to about 600,000 Medicare beneficiaries.

The program was not without its bumps. Thirteen of the 32 participating hospital systems dropped out along the way after failing to meet their targets.  

Officials said Monday that two of the ACOs had to pay significant amounts back to Medicare. That is because the incentives in the program work both ways, meaning if costs come in too high, they have to pay penalties. 

Earlier this year, the Obama administration announced the goal of tying 30 percent of Medicare payments to programs like ACOs by 2016, and 50 percent by 2018.  

Officials painted Monday’s announcement as a step toward that goal.

“This gives CMS greater confidence in scaling elements of the model to benefit people across the nation,” Patrick Conway, a senior CMS official, said in a statement. “And we are working to determine the best strategies for embedding the lessons we have already learned from the Pioneer Model into permanent Medicare programs and our nation’s health system.”

The MSO vs ACO Model

The MSO vs ACO Model

Model :    MSO

 

Recurrent revenue model for physicians based on quality of care with no risk to the physician. In this model the physician has no financial risk and will not have to pay any potential losses.

 

Payment

 

The physician gets paid a capitated amount monthly plus a quarterly bonus based on quality

metrics. The physicians revenue is based on performance and it is not dependent on the

other physicians in the MSO.

 

Contract 

Contracted with the managed care company. 

Time Tested 

Has existed for over 20 years and is time tested.

 

Number of enrollees

 Has no lower limit on Medicare enrollees.

 

Revenue

 

Provides substantially more revenue to the physician

 

 

 

Model :  ACO

 

Fee-for-service model with possible annual  bonuses based on shared savings on cost. In this model the physician is at risk to possibly have to pay back potential losses. 

Payment 

The physician does not get any capitated or quarterly bonuses, but just a possible yearly bonus. It is a risk model so the ACO could owe money back to CMS. The physician’s payments are pooled and NOT independent of the other physicians in the ACO.

 

Contract

Contracted directly with CMS. 

Time Tested 

New and no experience yet.

 

Number of enrollees

Needs a pooled base of 5000 Medicare members. 

Revenue 

Shares only 20% of the savings with the CMS. Therefore only 12% goes to

the ACO in the risk model. The ACO administration usually takes 50% so

potentially only 6% goes to the physicians pool.

 

 

For More Details : 305-227-2383   or 1-877-938-9311

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HPP Management Group, Corp

5201 Blue Lagoon Dr.

Suite 815

Miami, FL 33126

Accountable Care Organizations (ACO) - General Info

ACO

Definition:

 

What's an ACO? 

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. 

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. 

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. 

 

New models encouraging coordinated care?

 

The CMS Innovation Center offers a menu of alternative options, including:

•Comprehensive Primary Care initiative

•Bundled Payments for Care Improvement initiative

•Community Based care Transition Program

 

ACO do have Quality Measures in place [ 33 ACO Measures for PY2015 ]

 

For more information on ACO , please contact us at  :

 

305-227-2383   or  1-877-938-9311

 

To contact us by email :   fcortes@hppcorp.com     or   psilben@hppcorp.com