Medicare to divulge when a doc's patient is in an ACO

The CMS is making a more concerted effort to make sure doctors know which patients they're responsible for in Medicare accountable care organizations.

The CMS has updated the Medicare website to allow a beneficiary to list his or her primary-care doctor. If that doctor is in an ACO, the beneficiary would be assigned to both that provider and their ACO starting next year.

There currently are 480 shared-savings Medicare ACOs serving over 9 million beneficiaries.

An ACO is made up of a group of doctors, hospitals and other healthcare providers who coordinate care for patients. Despite ACOs garnering $466 million in Medicare program savings in 2015, many providers are still wary of the amount of risk the payment models require them to take on. Those concerns are amplified by not knowing which patients they would be evaluated for.

The CMS first announced it plans for the voluntary selection process earlier this year in response to providers telling the CMS they prefer to know with more certainty at the beginning of the performance year what beneficiaries the CMS will hold them accountable for.

Providers have complained about the current process under which patients are primarily assigned retroactively to ACOs. That means the CMS will tell a doctor at the end of the year which of their patients' care will be judged to determine success in raising quality of care while reducing costs.

The agency does this to ensure that doctors don't choose only their healthiest patients to participate in their ACOs.

"With the old methodology, the ACO and the physician did not have a real benchmark to measure their performance against," said Dr. Sanjay Seth, chief operating officer of HealthEC, a population health management company that works with ACOs to track patient care. "It was always a moving target."

The new patient selection option on the Medicare website will help eliminate the uncertainty now faced by clinicians over how they'll be assessed by the CMS, Seth said.

The change will also encourage clinicians to be more proactive in care planning for patients according to Dr. Ed Hett, chief clinical officer for Via Christi Health, a subsystem of Ascension based in Wichita, Kan., that operates an ACO.

The news would be even better if the CMS informed ACOs of all their patients at the beginning of the year and not just those who do the voluntary selection on Medicare's website, Hett said. It's unclear how many patients will make a primary-care declaration on the site and how the CMS is alerting beneficiaries about the option.

"The only con might be that we don't have the list of the entire panel, and then we may not be able to proactively manage those who are the sickest and in most need of our assistance," Hett said.

Dr. James Whitfill, chief medical officer at Scottsdale Health Partners, an Arizona-based physician network with 700 clinicians, said he is hopeful that this will make patients more trustful of getting care in an ACO if they know their doctor is participating in one.

"Many Medicare patients are skeptical about (ACOs) and often confuse them with 'Obamacare' or 'government takeovers,' " Whitfill said. "It will be interesting to see how much this increased attention around voluntary attribution impacts patients' attitudes."

Others said it's possible the voluntary selection could actually decrease ACO enrollment, which could cause hospitals to abandon the model.

If a beneficiary voluntarily aligns with a provider not participating in an ACO, the beneficiary would not be eligible for assignment to an ACO, even if the beneficiary would have otherwise been assigned to one under the current approach, according to Dr. Rhonda Medows, executive vice president for population health at Providence Health & Services, a Renton, Wash.-based system with 50 hospitals.

"This means a lower beneficiary volume for the Medicare Shared Savings ACOs," Meadows said. "Below a certain patient amount, it may not be advantageous for the health system to invest in an ACO."