Dermatology World July 2011 : Page 32
Dermatologists waiting for clarity give these organizations time to gain experience with population management before transition-ing to a model in which they incur more risk. The second option provides an opportunity for more experienced ACOs that are willing to risk paying a portion of the losses for a greater share of sav-ings. The 65 measures ACOs must meet focus on fi ve quality domains. They are patient experi-ence, care coordination, patient safety, preventive health, and at-risk population/frail elderly health. These measures align with those in other CMS programs such as the Physician Quality Report-ing System (PQRS). Therefore, an ACO that suc-cessfully reports the quality measures required under the SSP would also be eligible for the PQRS bonus. Benefi ciaries will be assigned to an ACO based on their primary care provider (PCP). However, benefi ciaries will be allowed to see any Medicare leaves specialists as a low priority in the current proposal. But over time, the plan is to broaden the system to incorporate our participation.” POtentiaL OPPOrtunities Down the line, options for a dermatologist to participate in an ACO may include becoming a member of a large specialty or multispecialty group, contracting with existing ACOs, becoming employed by a hospital that will join or form an ACO, or joining a network of individual practices to form an ACO. The proposed rule allows special-ists to join more than one ACO while PCPs can join only one. “Dermatologists in large tertiary care centers may be in a better position to dip their toes in the whole ACO methodology,” said Dr. Edison, who is concerned that the solo and small group practitio-ner will have a harder time doing so. “I don’t want them to be left behind,” she said. “We need every single dermatolo-gist in the country practicing because we are in such short Most dermatologists would be wise to supply.” Dermatologists take a wait-and-see approach. should be looking at their referral network to align for-mally or informally with these other physicians, Dr. Edison said. The provider they wish, even if the provider is not in latter may include PCPs; other dermatologists; the benefi ciary’s designated ACO. Mohs surgeons; plastic surgeons; and ear, nose, and throat specialists. “Dermatologists may be out DerMatOLOGists Out OF tHe LOOP there by themselves, but they share patients,” Dr. Some dermatologists are concerned that the role of specialists is largely undefi ned in the proposed Edison said. “Talk to the PCPs to fi nd out how to deliver better access to dermatologic services. One rule. “Right now, we don’t see dermatologists fi t-ting in very much at all simply because ACOs are option may be to off er teledermatology.” primary care driven,” Dr. Miller said. The cost sav-Next, she said, fi nd out who is forming ings generated by ACOs will primarily come from ACOs in the area. Depending on where one reducing hospital stays, expensive diagnostic in-practices, that could be an independent physi-house testing, and hospital readmissions. Derma-cian association (IPA) or a large community tologists very rarely hospitalize patients or utilize hospital. Large integrated delivery systems, expensive diagnostic tests such as MRIs, CTs, and multispecialty practices, and IPAs are very PET scans, he added. interested in forming ACOs, said Chet Speed, But because ACOs will be responsible for co-vice president of the American Medical Group ordinating the health care needs of the Medicare Association (AGMA) in Alexandria, Va. In fact, population, they must off er dermatology services many large integrated delivery systems have all as well as those provided by other specialists. the components of an ACO. Larger group prac-CMS’s intent is to initially focus on primary care tices and integrated health delivery systems will practitioners and high volume inpatient services be far more able to meet the requirements than because that’s where a lot of Medicare money is a fi ve-person dermatology practice, he added. being ineffi ciently spent, Dr. Wisco said. “That Hospitals, which don’t have a great track record 32 Dermatology WorlD // July 2011 www.aad.org
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