Dermatology World July 2011 : Page 30
Dermatologists waiting for clarity Those ACOs that lower costs while meeting quality measures defi ned by CMS will be fi nan-cially rewarded through the Medicare Shared Savings Program (SSP). “Like many of the new federal programs related to health care, such as health information technology, medical homes, and value-based purchasing, ACOs are an initiative for lowering costs and improving care,” noted Karen Edison, M.D., who serves on the American Academy of Dermatology’s ACO Workgroup. “This is CMS’s attempt to revise how we pay for health services because our cur-rent system is not really sustainable and health care costs keep going up.” Described as lengthy, complex, and vague as it relates to specialists, the proposed rule isn’t win-acOs DeFineD Under the proposed rule, an ACO refers to a group of physicians, hospitals, and other health care providers and suppliers of services that will work together to coordinate and improve care for Medicare benefi ciaries. An ACO may comprise the following groups of providers and suppliers: • Physician group practices, • Networks of individual practices of physi-cians and hospitals, • Partnerships or joint ventures between hos-pitals and physicians, or • Hospitals employing physicians. An ACO must apply to CMS to participate in the SSP. In order to be accepted, the ACO must serve at least 5,000 Medicare patients and agree to participate in the pro-gram for three years. providers This is CMS’s attempt to revise Participating will continue to receive how we pay for health services because payment under Medi-current fee-for-our current system is not really sustainable. care’s service system. Those ACOs that meet quality measures ning dermatologists over. “It has been conceived and achieve cost-saving targets, both of which are to improve care coordination and save money, established by CMS, will receive an additional both of which are very laudable goals,” said Robert payment through the SSP. Those that don’t will Swerlick, M.D., also a workgroup member. “But be held accountable for losses. According to CMS, I am very concerned that it will not achieve either the benchmark for determining whether an ACO goal as presently proposed.” earns a bonus will be “an estimate of what the “People need to keep in mind that the ACOs total Medicare fee-for-service Parts A and B ex-are voluntary at this point and only for Medicare penditures for ACO benefi ciaries would otherwise patients,” said Oliver Wisco, D.O., another work-have been in the absence of the ACO, even if all group member. Although he is also concerned of those services would not have been provided by that the proposed rule leaves many unanswered providers in the ACO.” The benchmark will take questions, Dr. Wisco believes that it will un-into account benefi ciary characteristics and other dergo a signifi cant amount of change between factors that may aff ect the need for health care ser-now and when ACOs are actually instituted. vices and will be updated annually for the three-“The SSP proposal is not perfect, but it is an year performance period that is slated to begin on important step in creating a better health care Jan. 1, 2012. system,” he added. CMS initially proposed two models for shar-In the meantime, dermatologists may want ing savings from which ACOs can choose; the to sit back and observe what is going on in their two models off er diff erent fi nancial benefi ts part of the country before jumping into the ACO and risks. In the one-sided risk model, the ACO pond. As Alexander Miller, M.D., another mem-would share in the savings for the three years and ber of the ACO workgroup, cautioned, “The fi rst share in the losses only in the third year. In the frog in the water may be the one consumed by the two-sided risk model, the ACO would share in a big fi sh.” This system has never been tested on a greater portion of the savings and share in losses broad scale, and whether or not it will work is all for all three years. The one-sided risk model is based on conjecture, Dr. Miller said. The one good seen as an entry point for organizations lacking thing about ACOs, he said, is that participation in experience with risk models, such as some physi-them is voluntary. cian-driven organizations or smaller ACOs. It will 30 Dermatology WorlD // July 2011 www.aad.org
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