ECMS.Sept.Oct._ECMS Bulletin 10/1/12 3:45 PM Page 1
www.escambiacms.org
SEptEmbEr/OctObEr 2012
BULLETIN
VOlUmE 42, NO. 5
Upcoming Events
Tuesday October 9, 2012 General Membership Meeting [1.5 AMA PRA Category 1 CreditTM] Speaker: Patricia Green, M.D. | Topic: “Breast MRI” Speaker: Bruce Horten, M.D. | Topic: “Breast Cancer Analysis”
Wednesday, November 7, 2012 General Membership Meeting In Conjunction with Strategic Health Intelligence Summit Topic: “Meaningful Use”
Saturday January 19, 2013 ECMS Annual Inaugural Ball President-Elect: Wendy Osban, DO Paul’s on the Bay
RSVP: 478-0706 info@escambiacms.org
Founded in 1873
Quality and Outcomes based Payment System Dr. George A.W. Smith Dr. George A.W. Smith In April of this year the Centers for Medicare and Medicaid Services (CMS) released the names of the first twenty seven Accountable Care Organizations (ACO’s) selected to participate in CMS’ Shared Savings Program. Our own Accountable Care Coalition of Northwest Florida established by Health First Network, Inc. was one of three Florida ACO’s to be included in that twenty seven. Health First Network is partnering with Collaborative Health Systems (CHS), a wholly – owned subsidiary of Universal American, established specifically for the Shared Savings Program and ACO development. In fact CHS supported the development of sixteen of the ACO’s that were approved by CMS. That brought the total number of ACO’s to sixty five including the thirty two groups participating in the Pioneer ACO Model as well as six organizations participating in the Physician Group Practice Transition Demonstration. The Shared Savings Program and other Accountable Care Organization initiatives are made possible by the Affordable Care Act healthcare law of 2010. It required CMS to establish this program to facilitate care coordination, improve patient safety, care for at risk populations and enhance preventive health services and patient experience. Ultimately it is designed to improve beneficiary outcomes at reduced cost. It will allow physicians who voluntarily agree to work together to coordinate care for patients and who meet certain quality standards, to share in any savings they achieve for the Medicare program. The success of the organization will be gauged by thirty three quality measures. CMS will automatically assign Medicare patients to the ACO and to their traditional physician who is participating in the ACO. Medicare will continue to pay individual physicians for specific items and services like it currently does under the Medicare Fee-For-Service payment systems. Patients may continue to see any doctor who treats patients with Original Medicare, regardless of whether their doctor is participating in an ACO, and they continue to have the ability to choose. The participating physician is required to notify beneficiaries that they are participating in an ACO, and
is eligible for additional Medicare payments. The beneficiary may then choose to receive services from the physician or from someone else. The beneficiary must also be notified by the physician that the beneficiary’s claims data may be shared with the ACO at the ACO’s request and must be given the opportunity to decline the data sharing arrangements. Care coordination will play a significant role in the success of any ACO and the Accountable Care Coalition of Northwest Florida will implement a Care Coordination Program. The outpatient Care Coordination Team will be the backbone of this program and may include a variety of caregivers including Registered Nurses and Social Workers. It will be assigned to patients based on their clinical and social needs and it will perform ongoing assessments, facilitating follow up care in conjunction with the patients Primary Care Provider. Other care coordination activities will include medication reconciliation and compliance monitoring; assessing home safety and mobility; assistance with activities of daily living (ADL) needs; patient and caregiver education on disease processes; identifying and coordinating Durable Medical Equipment (DME) and Home Health needs ; coordinating transportation needs and scheduling follow up appointments. CHS will play a vital role in an administrative capacity for the ACO. It will provide enhanced care coordination services such as telephonic in home nursing support, improved technology solutions and administrative services. CMS should have by now selected other ACO’s since the target was to have had one hundred and fifty by July of this year. It is believed that the first twenty seven ACO’s will provide care to nearly three hundred and seventy five thousand beneficiaries in eighteen states, include more than ten thousand physicians, ten hospitals and thirteen physician-driven organizations located in both urban and rural areas. It is one part of the Accountable Care Act that has bi-partisan support and will survive despite whatever else may happen with the law. Commercial and Medicaid payers are already trying to adapt the model to their populations.