ACO's Beginning to Take Form

Below is a recent article featuring Beacon IPA in Renal Business Today...


By Keith Chartier

Like many physicians, Long Island, N.Y.-nephrologist Simon Prince sees a volatile situation in which more and more physician practices are becoming hospital owned amid a turbulent healthcare landscape.

In fact, a recent survey of 58,000 physicians by the Medical Group Management Association found that 55 percent of physician practices were hospital owned in 2009. In 2008, 50 percent were hospital owned, and approximately 30 percent were five years before.

“There are a lot of reasons in which docs are doing that— decreasing reimbursement, fear of the unknown of what’s coming in healthcare reform and just people throwing the towel and not wanting to deal with it, rising administrative burdens, oversight, tech requirements, etc.,” Prince said.

However, he believes there is still a critical mass of independent, private-practice doctors who like being autonomous. “We still need to come together, because it’s just too hard to remain in your silo,” Prince added. “Those days are over, but private practice still isn’t dead. The sky isn’t falling. There is still some opportunity if we can come together.”

This past summer, Prince spearheaded the development of Beacon IPA, which includes a network of more than 200 local physicians who can share costs, risks and accountability for quality of clinical care. It’s a model that may sound familiar to the healthcare hot topic of the day: accountable care organizations (ACOs).

Prince is well aware of the possibility of ACOs, and has already started laying the groundwork of moving Beacon IPA into an ACO when and if that day comes. In the meantime, the organization is striving to help physicians maintain some semblance of autonomy in a merger-happy world.

“We are striving to evolve into an accountable care organization (ACO) and make a difference in healthcare,” added Prince. “ACOs have rapidly gained importance under the healthcare reform legislation introduced by President Obama. Although many questions remain about the viability of ACOs, we at Beacon embrace its philosophy. Beacon IPA is owned and operated by physicians, and we will make every doctor in our network accountable for their performance. The success of our venture will be of great benefit to all parties involved, including our patients, physicians and insurers.”

ACO Basics

When healthcare reform passed in early 2010, ACOs were tucked deep within the law's pages and weren't on the forefront of the national consciousness. That should change this year as Medicare works to set the rules and regulations that will govern ACOs, which are set to start no later than Jan. 1, 2012.

Under the law, qualifying provider groups are to work together to manage and coordinate care for Medicare fee-for service beneficiaries. In addition, the law stipulates that ACOs that meet quality performance standards are eligible to receive payments for shared savings.

According to the law, the following groups are eligible to participate in ACOs: physicians and practitioners in group practice arrangements, networks of individual practices, partnerships or joint venture arrangements between hospitals and ACO professionals, hospitals employing physicians and practitioners, and any other group Medicare deems appropriate.

Also, an ACO must have an established, formal legal structure, and it will also be required to participate in the program for no less than three years. Another eligibility criterion is that ACOs must have at least 5,000 patients in order to participate. In addition, ACOs are mandated to have a leadership and management structure that includes clinical and administrative systems. ACOs must also have defined processes to promote evidenced-based medicine, report the necessary data to evaluate quality and cost measures (this could incorporate requirements of other programs, such as the Physician Quality Reporting Initiative (PQRI), electronic prescribing (eRx), and electronic health records (EHR), and coordinate care

Shared Risk

It has been argued that the current fee-for-service payment system rewards volume and intensity rather than efficiency and effectiveness of care, often penalizing those systems that attempt to improve care. In contrast, the ACO system, in a perfect world, would reduce cost while increasing quality of care. There are, however, risks.

“What all docs are worried is that you share in the risk,” Prince said of ACOs. “That’s the biggest unknown. Who is going to share in the risk? If they’re going to put the risk back on to the ACO and onto the physician, it’s going to be more difficult and we could start self selecting which patients we want to include in our ACO.”

Click here for the rest of the article.

An Accountable Care Organization Administrator and Patient Dialog About Being in an ACO

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ACO's as part of the ACA healthcare refrom law

EHR Incentive Programs Ready For Launch

Eligible healthcare professionals and hospitals can begin registering to participate in the Medicare and Medicaid electronic health record payment system. 

By Nicole Lewis ,  InformationWeek 

December 30, 2010 11:45 AM


The Centers for Medicare and Medicaid Services (CMS) has announced that registration for its Medicare and Medicaid Electronic Health Record (EHR) incentive programs will begin January 3, 2011.

"With the start of registration, these landmark programs get underway, and patients, providers, and the nation can begin to enjoy the benefits of widespread adoption of electronic health records," Donald Berwick, CMS administrator, said in a statement. "CMS has many resources available to help providers register and participate, and we look forward to working with eligible professionals and eligible hospitals to facilitate the process, beginning on January 3rd and going forward."

"It's time to get connected," said David Blumenthal, head of the Office of the National Coordinator (ONC) for health IT. "ONC and CMS have worked together over many months to prepare for the startup on January 3rd."

Blumenthal also said ONC's certified health IT product list includes more than 130 certified EHR systems or modules and is updated frequently. ONC also has hands-on assistance available across the country through 62 Regional Extension Centers.

"We look forward to continuing to work with CMS to assist eligible providers in 2011 and future years." Blumenthal added.

Eligible professionals and eligible hospitals must register in order to participate in the Medicare and Medicaid EHR incentive programs, and can do so at a registration site maintained by CMS.

According to Berwick, the benefits of EHRs are widely recognized, and support for the incentive programs is strong in the healthcare field and among policymakers. He also said the changeover from paper to electronic records will be challenging for clinicians and hospitals, but CMS and ONC have taken steps to ease the transition.

"We've provided flexibility in meeting the meaningful use requirements, both agencies have conducted extensive outreach, and we have the resources in place to help providers acquire certified EHR technology and meet the programs' requirements. Immediate registration is not required, but we encourage eligible providers to sign up as soon as they have certified EHR technology and are prepared to participate. We are ready to help," Berwick said.

To prepare for registration, CMS said, interested providers should familiarize themselves with the requirements on the Medicare and Medicaid EHR incentive programs' Web site. The site provides information on the programs, including tabs on the path to payment, eligibility, meaningful use, certified EHR technology, and frequently asked questions.

CMS announced the following key dates in 2011 for the Medicare and Medicaid incentive programs:

Jan. 3: Registration for the Medicare EHR incentive program begins. States that are ready may launch their incentive programs for Medicaid providers.

January 2011: Some state agencies begin issuing Medicaid EHR incentive payments

April 2011: Attestation for the Medicare EHR incentive program begins.

May 2011: Issuing of Medicare EHR incentive payments expected to begin.

July 3: Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR incentive program for federal FY 2011.

Sept. 30: Federal FY 2011 payment year ends at midnight for eligible hospitals and critical access hospitals (CAHs).

Oct. 3: Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 to demonstrate meaningful use for the Medicare EHR incentive program.

Nov. 30: Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for federal fiscal year 2011.

Dec. 31: Calendar 2011 payment year ends for eligible professionals.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and CAHs when they adopt certified EHR technology and successfully demonstrate meaningful use of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

According to CMS, professionals who meet the eligibility requirements for both the Medicare and Medicaid EHR incentive programs must select which program they wish to participate in when they register. They cannot participate in both programs; however, after receiving payment, they may change their program selection once before 2015. Hospitals that are eligible for both programs can receive payments from both Medicare and Medicaid.

Under the EHR incentive programs, eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology.

Winthrop EMR Subsidy for Beacon Members

There is a sizable subsidy available through Winthrop University Hospital for physicians who have not yet signed with an EMR vendor. This subsidy is open to all physicians on staff at Winthrop, or BIPA physicians who may wish to get privileges at Winthrop.

If you are interested, please let me know.

Why Beacon IPA (Updated)

WhatisBeaconIPA_20101118