ACO veterans share lessons from the trenches at MGMA

Stephen Nuckolls, CEO of Coastal Carolina Health Care, New Bern, N.C., shared some lessons at the Medical Group Management Association annual conference yesterday from his organization's experience in running a Medicare accountable care organization.

He said that when his organization was forming its 50-provider accountable care organization, hiring a consultant was money well-spent, but outsourcing the staff of its after-hours call center was not. The consultant offered concrete steps to advance the ACO goal of keeping people out of the hospital and emergency department. But the employees of the contracted call center company worked against that goal.

Coast Carolina is part of the CMS Advance Payment ACO Model program designed for physician-based and rural providers that need financial assistance in launching an ACO. Nuckolls told his story at the MGMA annual conference in San Diego. He said his organization hired 11 care managers but did not hire extra staff to work at its call center. The system's new 24/7 nurse triage line was supposed to assess patients' complaints and determine the appropriate course of action. Nuckolls said the outside company didn't know his community and tended to refer patients to the hospital emergency department.

Donald Stumpp, manager of payer contracting with Indianapolis-based American Health Network, told a similar story at the conference. He noted how the typical voice-mail message for health systems instructs patients to call 911. But under an ACO model, he said the sickest 10% of an organization's patient panel should be instructed that it's OK to call their doctor or care manager at night or on weekends.

The government shutdown stole a little bit of the session's thunder as the CMS was expected to post first-year results of the Advance Payment ACO program last Friday but did not because of the shutdown. On the whole, however, panelists said they were generally happy with how the CMS was operating the program.

Gary Garspard, CEO of Wichita Falls-based Clinics of North Texas, said the CMS often had been unresponsive in the past. But he said CMS staff have been “wonderful” since the program began, with conference calls every two weeks and generally replying within 24 hours to any questions. "I couldn't think of a better partner to do this with," Garspard said.

There is uncertainty about how the program will play out. When asked if he could recommend a model for how to split physicians' share in the savings the ACO generates, Garspard responded that if you have a physician payment model this year, you are likely to have a different model next year. But, he added, "physicians want to practice this way anyway."

While it's unknown at this point whether Coastal Carolina met its mandated 3% savings target to garner shared savings, Nuckolls said changes such as adding medical scribes to help physicians with electronic health-record charting have improved financial performance, with doctors gaining the time to see at least three more patients a day. For the ACO patient panel, emergency department visits have dropped 30% to 40% and hospitalizations decreased 10% to 15%.

In the midst of uncertainty, he said his group has kept focused on its strategy of looking at "where we can really make a difference."

"It all comes down to physician engagement," Nuckolls said. "There is a reward for changing behavior."

Follow Andis Robeznieks on Twitter: @MHARobeznieks