COMMENTARY

Understanding What the ACA Means for Ophthalmology

American Academy of Ophthalmology 2013

Roger F. Steinert, MD; Nancey K. McCann; Brock K. Bakewell, MD

Disclosures

November 22, 2013

In This Article

Incentives, Disincentives, and Punishment

Dr. Steinert: The way it is headed now is that the primary care groups have a very strong desire to have savings, not costs, at the end of the day, and the only way they can make that happen is to have the specialists cooperate, in a sense, in that they are equally incentivized. Is that right?

Dr. Bakewell: Yes. There may be a disincentive to provide services, just like there was in HMOs originally to save money and to potentially get a bigger bonus at the end of the year when it is looked at retrospectively.

Dr. Steinert: In addition to money, there are some quality measures that are part of the CMS incentive. Is that right?

Ms. McCann: ACOs have to participate in the Physician Quality Reporting System (PQRS). Right now there is still an incentive payment. There is a bonus payment, but that goes away starting in 2015. 2014 is the last year with the positive incentive, and in 2015 it becomes punitive if physicians don't participate. If you are participating in the ACO, the ACO has to also report on these quality measures as well.

Dr. Steinert: So in Tucson, have ACOs started to form, and how many do you have?

Dr. Bakewell: We have 1 ACO. I have not joined it yet. In Phoenix there are about 6 ACOs present currently. Phoenix is only 110 miles from Tucson, so definitely the more populated areas have ACOs. I have a map of the ACOs and most of it looks yellow (meaning that there are no ACOs), but the metropolitan areas -- the highly populated areas -- have the ACOs.

Dr. Steinert: So there is the potential at least to be a major barrier for patient access.

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