10 Things You Need to Know to Succeed and Be Happy in an ACO

Leigh Page

Disclosures

July 28, 2015

In This Article

ACO Medical Directors Say: Here's What We Want You to Know

Accountable care organizations (ACOs) can seem complex and unfamiliar to physicians—even those who are participating in one of them. There are risk-taking and shared-savings arrangements, both of which depend on a hospital- or physician-led organization meeting goals tied to quality measures, but each model uses different formulas to allow physicians to share in any potential savings.

Because the ACO concept is fairly recent, doctors may feel confused and anxious about how they'll maintain and grow their income, especially in an environment where they already feel as if they're a big cost-cutting target.

Here, five medical directors, serving at a variety of Medicare ACOs, present 10 straightforward—and often eye-opening—points they think doctors need to know about this emerging care-delivery model.

1. Concerns About Losing Money Currently Affect Only a Minority of Physicians

Many doctors are concerned about losing money and are skeptical about making money in ACOs, but the medical directors we spoke with think these concerns have been exaggerated.

At the Medicare ACO run by BJC HealthCare, a large health system in St Louis that includes both independent and employed doctors, "physicians have zero financial risks," according to the ACO's medical director, Douglas Pogue, MD.

That said, if an ACO in the Medicare shared-savings program (MSSP) doesn't produce any shared savings, there's the possibility that doctors in some arrangements could be forced to pay a sizable penalty—potentially several millions of dollars. However, this scenario only applies to a handful of MSSP ACOs that accepted "downside risk" in meeting savings targets. These ACOs agreed to this arrangement because it made them eligible for higher bonus payments if they did save money. But the majority of MSSP ACOs, including the BJC HealthCare ACO, didn't accept downside risk, and doctors in these organizations have absolutely no risk of paying penalties at this time.

This is likely to continue for another 3.5 years. Under the current version of Medicare ACO regulations, all MSSP ACOs would be required to accept downside risk in January. However, the Centers for Medicare & Medicaid Services (CMS) is proposing[1] to extend the deadline for required downside risk to 2019, and the agency is expected to adopt this change in final rules due out this summer.

Many ACOs, including BJC HealthCare, hope to be making bonuses as they learn the ropes in the next few years. Dr Pogue says his ACO is producing $3 million a year in savings—still shy of its target of $4.5 million to qualify for a bonus payment—but he's confident that his fledgling organization will reach the target in time.

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