Physicians should educate themselves on their potential role in an accountable care organization (ACO) model and make sure they know their options before the Centers for Medicare & Medicaid Services (CMS) approves ACOs for the Medicare Shared Savings Program (MSSP) beginning next year, according to an article in the September issue of the Journal of the American College of Radiology.
Robert E. Schiller, Esq, and Debra A. Silverman, Esq, of the law firm Garfunkel Wild, P.C., in Great Neck, N.Y., said the ACO model has a number of potential benefits, but also much uncertainty, and physicians should start preparing now.
“To protect yourself, you need to be proactive,” wrote Schiller and Silverman. “Use professional societies and other networking resources to make sure you are in the loop and aware of potential developments concerning ACOs in your area, as early as possible.”
If a physician discovers that an ACO is being developed in the area, Schiller and Silverman wrote that the physician should try and find out a number of important details, including who the driving forces are behind development, whether any payors are involved, how the ACO is to be funded, what obligations could be imposed on the ACO’s providers and how compensation would be handled. The authors suggested tracking down the ACO’s plan, proposed structure, payor strategy and financial projections.
The authors also suggested that physicians should consult with their own attorneys and not rely exclusively on the opinions of the ACO’s attorneys since the latter will be be looking out for the interests of the ACO.
Schiller and Silverman pointed out that if an ACO is successful, there are a number of benefits including improved quality of care and greater cost efficiency, potentially leading to increased reimbursement under “shared savings” or similar incentive programs.
But success is not guaranteed, according to the authors, and ACOs will come with multi-million dollar startup costs, as well as numerous regulations regarding the sharing of downside risk and requirements that 25 percent of any savings be withheld as a reserve against potential future shortfalls. Even if successful, physicians may feel some loss of control and have more administrative responsibilities, according to the article.
For those who decide to remain outside of a local ACO, they run the risk of losing patients to specialists within the ACO. Schiller and Silverman predicted services like radiology will most likely be handled by providers who are part of the ACO, even if this is not required.
Some of the decision at this point may be hypothetical as federal regulations are subject to revisions, but the authors said now is the time to closely examine the risks and benefits of joining a local ACO.
“Either way, make sure the decision is yours and that it is an educated one,” concluded Schiller and Silverman.