Program aims to reduce costs, boost care

    Transitioning patients from one care setting to the next is often fragmented and costly as a result of unclear communication and providers receiving different, disconnected payments. A seamless, shared savings program implemented through the Centers of Medicaid and Medicare Services (CMS) will reward doctors, hospitals and long-term care providers who join together to lower growth in health care costs while meeting performance standards on quality of care.
    The basic premise of ACOs is to create incentives for health care providers to work together to treat a patient across the continuum of care, including doctors’ offices, hospitals, and long-term care facilities. The impetus for improving coordination and communication among care providers through ACOs is to not only improve the care Medicare beneficiaries receive, but also to help lower costs.
    An analysis of the proposed regulation for ACOs showed that Medicare could potentially see as much as $960 million over three years in savings from things such as fewer hospital readmissions and less duplication of medical tests. Medicare will share up to 60 percent of its savings with providers who meet its quality standards while keeping costs below benchmarks set by the federal government.
    Not all health care providers will be part of an ACO in 2012. Providers must form or join an ACO and apply to CMS. If accepted, a provider must serve at least 5,000 Medicare patients and agree to participate in the program for three years. Under the federal guidelines, providers have to inform Medicare beneficiaries if they are going to participate in an ACO. If a Medicare patient does not wish to receive care coordinated by the new entity, the beneficiary can select another provider. However, the patient may see reduced costs when receiving care through the affiliated partners.
    In recent months, physicians, hospitals, and skilled nursing and rehabilitation centers have been gearing up to build alliances that qualify as an ACO. In my position as a skilled nursing center administrator and president of the state’s largest association of skilled nursing providers, I’ve witnessed the formation of various “teams” that have begun the exciting work of developing new ways of working together to better serve those we care for.
    Consumer buy-in will be crucial to ACOs’ success so enhanced care is an intrinsic part of the new model. Between visit care will be a major benefit to help manage patient care and prevent the need for future acute care. For individual provider participants, the need to step up to the plate in terms of quality will be inherently necessary. ACO partners will not want to carry other providers who don’t do their part to meet quality benchmarks and keep costs down, both benefits to the end user.
    The formation of ACOs is complex, and there are sure to be bumps in the road. But while the outcome of this new model of care remains to be seen, it’s hard to argue with its intent.  The building of cooperation between providers in order to deliver better and more cost efficient care is a goal we should all support.

    Joan M. Woods is chair of the Rhode Island Health Care Association (RIHCA), a nonprofit association comprised of about two-thirds of the state’s skilled nursing and rehabilitation facilities. She is also executive administrator of the Genesis HealthCare Grand Islander Center in Middletown. She can be reached at (401) 849-7100 or joan.woods@genesishcc.com.