#36: Profiting From the Affordable Care Act & Joining an ACO

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  1. #1 Jul 18, 2014
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    AdminWolf

    AdminWolf Site Administrator & Tech Lead
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    Episode 36: Profiting From the Affordable Care Act & Joining an ACO

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    Frequent ODwire.org contributor Dr. Richard Frankel discusses how ODs can profit from the Affordable Care Act, and the nuts-and-bolts of joining an Accountable Care Organization (ACO), which is a critical program for expanding your patient base & ensuring you won't be left behind.

    *** IMPORTANT: The deadline for clinicians joining an ACO & participating in 2015 is August 17, 2014. You need to hurry up & get the process started to avoid being left out.

    Listen to the radio show for instructions on how to get started & read the discussion thread below.
     
  2. AdminWolf

    AdminWolf Site Administrator & Tech Lead
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    Joining an ACO for 2015 (you'd better hurry...)

    I'm cutting-and-pasting instructions from Dr. Frankel that he gave in another thread...

    1. An ACO is the new managed care structure. The purpose is to reduce costs by 2% per year by increasing efficiency of care through the PCP .its been said a bunch of money providing a bunch care to a bunch of people for the year. Money left over is a bonus. No money left over leads to a trip to the wood shed.

    2. Originally designed to be owned by hospitals, the regulations have been changed to allow other ownership such as insurance companies.

    3. Panels of providers will provide the care. You've got to be on it to have equal access to the enrollees. You must prove to the ACOs that you are a wonderful dr. They want to know your background and your history in practice. If you've robbed a bank, forget it, they want to know if you're a criminal. In s nutshell, that vetting process is called credentialing. The CAQH has helped automate the process

    4. As an inducement to join, the number of providers is limited to insure adequate patient flow as well as limiting the overhead costs for the ACO. Panels need to be populated by providers where the enrollees are, not where they ain't . So concentrate your efforts within a 25 mile radius.

    5. I wanted your state associations to do this next step for you, but your emails tell me they didn't . ACOs must licensed by the state, I wanted them to compile a list including contact numbers. They didn't so you have to either contact the state for the names and numbers or try google. This is not a time for emails, but personal phone calls. Ask for their plans for an ACO and if they can send you an application either by mail, or on line ,as well as a packet of I formation including fee schedules .

    6. Contact provider relations for every insurance company you deal with. Repeat step 5 with one addition. Ask if your credentials can be transfered to the ACO. This will expedite your being iincluded in the panel.

    7. Call the Med Staff office of every hospital within your practice demographics. Ask if the hospital is starting an ACO and if they are,the phone number of the contact person. If they are not ,ask if they are aligning with any ACOs. Again, ask for contact names and numbers. Repeat step 5. Follow up all conversations with letters.

    8. More of your income is going to be derived from professional rather than material fees. We need to achieve parity of panel access and parity of professional fees. As our scope of practice has increased, so has our ability to treat a greater range of patients in a more cost effective manner. This makes us more attractive to the ACOs. Less OMDs will be necessary for the panels and more ODs required.

    9. Make sure that the state associations have firmed up our legal protection as well as scope of practice . I detailed this previously. It will help if you run into any problems.

    10. Start tomorrow !

    I tried to simplify this as much as possible. Hope this helps.

     
  3. AdminWolf

    AdminWolf Site Administrator & Tech Lead
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    I'm curious -- would anyone like to share their experience of joining an ACO? was it a paperwork nightmare, or pretty straightforward?
     
  4. Richard Frankel

    Richard Frankel Well-Known Member

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    Adam,

    Joining an ACO is pretty straight forward. Two ACOs involved nothing more than a quick signing of contracts with office address and NPI and CAQH numbers. All four of them did background checks as well as contacting the Med Staff office of the hospital where I have my privileges. Right now, there is a time factor in applying to participate in MSSPs for next year. The paperwork to CMS needs time to go through.

    I've been receiving a lot of emails discussing your progress in joining and questions you have. Could you please post them here for a while. It's important that ODs understand the number of ODs who are applying. This is not something to put off for another day.
     
  5. Frederick Frost

    Frederick Frost ODwire.org Supporting Member

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    For those in the state of Ohio, you can contact the Ohio optometric Association, and they do have a list, and are emailing it to me Monday. For those who are interested.


    Fred


    Sent from the ODwire.org Mobile App
     
  6. #6 Aug 5, 2014
    Last edited by a moderator: Aug 14, 2014
    Richard Frankel

    Richard Frankel Well-Known Member

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  7. Richard Frankel

    Richard Frankel Well-Known Member

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    With one week to go for the MSSP provider enrollment deadline for 2015, let's clarify some misconceptions:

    1. In year one of the MSSP, the financial incentives are achieved by merely reporting the 33 metrics. It's like a take home test. In year 2, there are 25 performance based metrics and year 3 all 33 are performance based.

    2. In 2017, we switch to a system of shared risk. This is part of the Medicare SGR legislation. You must have a significant number of patients enrolled in AMPs or Alternative Method of Payment Plans. MU is in the legislation, and you can report as a group, which avoids individual errors. Penalties will increase to 9%.

    3. If you are not happy being a participating provider, you can resign from the panel.

    4. Medicaid ACOs are forming, they are separate from MSSPs. There are also commercial ACOs. Some studies are projecting a conversion of 40% of the current policies to ACOs.

    5. There are 3 revenue streams in an ACO,
    A). Increase in patients due to an increase in referrals
    B). Fees for coordinating care
    C). Financial incentives for achieving target metrics

    In terms of what I have seen in the first 8 months, stream A will probably dwarf stream C in terms of dollars. The new referral patterns are working well. The fee schedule is on par with other professions, as is access to patients. Makes you wonder if existing participants are trying to keep the number of participating providers down by making disparaging remarks.
     
  8. Richard Frankel

    Richard Frankel Well-Known Member

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    I received an email today from the ACO/MSSP. They are distributing first quarter address file checks today to the participants. We are looking at $4000. I have no idea what an address file check is, but I'm not complaining. The checks were mailed today.
     
  9. Richard Frankel

    Richard Frankel Well-Known Member

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    Yesterday, I received a phone call from one of the attendings in the ER at the hospital where I have my privileges. One of my patients who I had seen as an MSSP beneficiary, was there complaining about her eye being painful. She is a pseudophake, and has had a corneal transplant in the affected eye. The attending was looking for direction from me. I asked her some questions about the findings, offered to see the patient in the ER , however , she felt it could wait till today.

    I just saw her now, gave her scripts and will follow up with her to monitor her progress. The point of this post isn't to discuss the treatment plan, but to show Optometry's integration into the healthcare landscape. Consulting and treating has become a routine occurance. It's your patient handle it.

    I will be calling the attending back today, to discuss my findings and plan of treatment.