At the 11th Annual Orthopedic, Spine & Pain Management-Driven ASC Conference in Chicago on June 15, gastroenterologist John Venetos, MD, gave a presentation titled "How Doctors Form ACOs — A Success Story."
"We were seeing that physicians were being recruited and bought by various hospital chains and we wanted the physicians to be able to have a response to this," said Dr. Venetos. "As a result we began to have small group discussions to become proactive and find a solution to healthcare reform."
Several independent physicians in Dr. Venetos' market decided to join together to form an independent physician association. Every physician member was also an owner, and kept their own tax ID numbers so the IPA didn't turn into a multispecialty medical practice. The physicians were then able to form an accountable care organization. The size of the group meant they had enough infrastructure to support an ACO under the category of a group of independent practices without any specific hospital affiliation.
"When the new rules and recommendations were released in October of 2011, by reducing the quality measures to 33, and eliminating some prior hospital-associated measures, this allowed ACOs composed of independent physician groups to successfully report the 33 quality measures," said Dr. Venetos. "In addition, the initial requirement of having more than 50 percent of primary care physicians use an EMR was changed."
The philosophy for the ACO was:
1. 100 percent physician ownership
2. Physicians were independent
3. Transparency at the board level and within the ACO
4. Open access
5. Growth and marketshare
6. Shared savings distributions
7. Work with all hospital systems
8. Have a payer-agnostic management vendor
9. Continue to be proactive with strong medical leadership and commitment from independent physicians
Physicians were able to buy into the ACO at $500. Coordinating the ACO involved several meetings and an enormous amount of time away form the clinical practice, but once the organization was up and running it ran smoothly. The ACO helped physicians transition from fee for service to fee for value payment methods
"In order for us to grow, we have to go out and recruit the best and busiest physicians to work with us," said Dr. Venetos. "We wanted to maintain our independence so we could recruit physicians from all hospital systems throughout Chicagoland."
Figure out how your physicians will be able to provide the best value and educate them on maximizing their resources. "Do workshops to give the physicians new information about things they can do to increase value to their patients and reduce cost," said Dr. Venetos. "Additionally, big legal firms will say you need a lot of money to start the ACO; what you actually need is a few people who are dedicated, intelligent and with strong medical leadership skills."
Quality reporting is also very important for ACOs. "Get the physicians and their staff involved in quality reporting if you want these initiatives to be successful," said Dr. Venetos. "We trained the physicians on how to do PQRS, and picked the measures that were part of the quality measures needed for the ACO, so when we started the ACO they weren't reporting anything new."
In his group's model, Dr. Venetos said physicians get to bill fee for service with the shared savings distribution that clearly rewards improving quality with better health and lowering healthcare costs.
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