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

Leigh Page

Disclosures

July 28, 2015

In This Article

For Some Doctors, Bonuses Are a Reality

Already, at physician-run Palm Beach ACO in Florida, doctors are making a significant amount of money in bonuses. In CMS's first distribution of MSSP bonuses last year, Palm Beach received nearly $11 million by saving Medicare $22 million in projected costs.[2]

Each ACO can distribute the bonus as it sees fit. At Palm Beach, each physician received an average of $63,000. Lenny Sukienik, DO, one of Palm Beach's medical directors, says this included a baseline amount, plus payments based on the amount of money each physician saved and the number of Medicare patients each one treated.

Still, Palm Beach is a rare bird. Only about one half of ACOs reduced Medicare spending in the first measured period, and just one quarter actually produced enough savings to earn a bonus. But it shows that it can be done without a decline in quality, on the basis of 33 different measures against which each ACO has to demonstrate competency.

Dr Sukienik says that a key ingredient in Palm Beach's success was working closely with each physician and continual oversight. A medical director or stand-in meets with each physician for 30-40 minutes at the doctor's practice once or twice a month, and ACO representatives also meet regularly with staff at each office. "It's really important to engage the entire office and not just the physician," he says.

Particularly in physician-run ACOs, doctors may have to contribute to start-up and ongoing operational costs, but Dr Sukienik says Palm Beach has kept these costs low. To set up operations, "we didn't ask for bank financing or money from a hospital," he says.

Palm Beach runs a tight ship. Operating a small ACO is estimated to cost around $800,000 to $1 million a year, but Dr Sukienik says Palm Beach spends well below the normal amount because, for example, it doesn't hire care coordinators—nurses who make sure patients are following their care plan. Doctors and their staffs do the work themselves, he says.

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