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

CMS Expects to Issue ACO Rules by Mid-January 2011

The Centers for Medicare & Medicaid Services could release the proposed regulations for accountable care organizations (ACOs) by mid-January 2011, according to a posting from the law firm McDermott Will & Emery.

The law firm reported that on Dec. 3, Head of CMS, Donald Berwick, and Jonathon Blum, deputy administrator of CMS and director of Medicare, made the announcement while speaking at during the annual policy conference of the National Committee for Quality Assurance.  They also announced that Medicare beneficiaries will be notified when they are assigned to an ACO.

One-Year Medicare Doc Fix Clears Senate and House

Following the Senate's lead yesterday, the House approved a one-year "doc fix" Thursday afternoon that will prevent a dramatic cut in Medicare physician payments.

The measure was approved in a 409-2 vote today by the House, one day after the Senate approved the $19.2 billion fix by unanimous consent. 

Without the action, Medicare payments to doctors would have been cut 25 percent on January 1st. 

AMA makes recommendations to CMS for physician-led ACOs

The AMA submitted its most detailed comments (PDF) to date to the Centers for Medicare & Medicaid Services (CMS) on how Medicare should structure physician-led and patient-centered accountable care organizations (ACOs). The recommendations were submitted today, Dec. 2, in response to a specific request from CMS for comments on how to ensure that solo and small group practices have the opportunity to actively participate in Medicare's ACO program. 

Top recommendations 

The AMA's recommendations to CMS on structuring physician-led ACOs include:

• Developing new payment models for physicians that move Medicare away from today's dysfunctional physician payment system—the threat of Medicare physician payment cuts will impede physicians' efforts to improve care coordination, such as employing case managers and investing in infrastructure to monitor and improve quality
• A range of specific new payment methods that CMS should consider in addition to shared savings, including an accountable medical home payment system and bundled payments for specific medical conditions, such as congestive heart failure
• Increased access to loans and grants for small physician practices
• Easing of antitrust restrictions that prevent physicians from collaborating
• Timely access to quality data

The AMA also urges CMS to allow patients to voluntarily select a Medicare ACO and to undertake a proactive effort to educate and encourage beneficiaries to take steps that will help make ACOs successful. For example, patients should be able to:

• Choose and consistently use a primary care physician as a medical home
• Select specialty physicians, hospitals and other providers that coordinate effectively with their primary care medical home and each other
• Engage in shared decision-making processes with their physicians about appropriate treatments for their conditions
• Participate in other types of programs developed by their physicians to maintain and improve their health at an affordable cost

This education effort should be developed in cooperation with physicians and launched well in advance of the ACO program's initiation. 

The AMA also makes recommendations on the types of quality measures ACOs should use. At least in the initial years of the program, CMS should avoid making ACOs collect and report quality measures beyond those already required under other CMS programs, such as the Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative. 

Although additional quality measures may ultimately be warranted, it is impractical to develop a single national set of such measures prior to implementation of the Medicare Shared Savings Program, because the areas where ACOs will focus their cost reductions will likely vary significantly from region to region. Furthermore, measures that may be appropriate for one ACO model may not be appropriate for another. ACOs should be allowed to report on a hybrid of nationally and locally focused quality measures related to their particular patient population. 

Physician-led ACOs will encourage innovation, competition 

When the AMA submitted its comments, AMA President Cecil B. Wilson, MD, said, "The physician-led ACO model injects competition into the market by eliminating the need for consolidation under a hospital system. Competition fosters innovation, which ultimately helps patients receive efficient, high-quality care. Care coordination is vital, and physicians can work together with a health care team to keep patients healthy and out of the hospital while maintaining independent medical practices. CMS should adopt policies that facilitate physician-led ACOs and do not inadvertently bias participation in favor of large health systems and hospitals. Our goal is to ensure that new models of care benefit patients, and for this to happen physicians must be able to successfully participate in and lead ACOs." 

Learn more about the AMA's advocacy efforts on ACOs.

PhysiciansPractice.com- Trendspotter: Featuring Beacon IPA

Trendspotter: Fledgling IPA Charts Its Own Course

By Ken Terry | November 24, 2010

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Accountable care organizations (ACOs) are supposed to improve quality and cut costs by getting hospitals, doctors, and other providers to work together. But increasingly, observers are raising the possibility that ACOs might raise costs faster by consolidating providers and forcing payers to accept big payment increases.


The main reason for this concern is that hospitals are expected to be the driving force behind the ACO trend. As they grow by acquiring other hospitals and employing more physicians, healthcare systems are becoming ever more influential in many markets. The advent of ACOs promises to increase that dominance — assuming the government lowers the antitrust and other regulatory barriers to forming these organizations.

But hospitals need not control ACOs. In fact, under the health reform law, they don’t even have to be ACO members, although their cooperation will be needed. The American Medical Group Association (AMGA) has started an ACO collaborative to help large group practices form ACOs. There are also clinically integrated IPAs and PHOs that could easily become ACOs, and 50 to 75 other physician-led organizations are on the same path, according to one estimate.


Among these entities is the Beacon IPA of Manhasset, NY, on the north shore of Long Island. Formed last summer, the IPA already has about 200 physician members, according to nephrologist Simon Prince, the IPA’s leader. The IPA’s long-term goal, Prince says, is to become clinically integrated and ready for whatever healthcare reform brings, including ACOs.


The IPA is not affiliated with any hospital “by design,” says Simon, the immediate past president of the medical staff at North Shore University Hospital in Manhasset. “We are trying to remain free agents.” Instead of being part of a hospital strategy, he says, the IPA wants to create its own strategy.


The main impetus for formation of the IPA, he explains, is the growing power of the North Shore-LIJ Health System, which is the dominant healthcare player on Long Island. North Shore-LIJ has hired a lot of physicians, creating fears among some private-practice doctors they might not be able to survive on their own.


“A lot of doctors didn’t go into medicine to become employed physicians, but the environment is such that it’s very difficult to maintain your independence,” Prince says. “So I felt an IPA was the best alternative that would allow the individual practices to maintain as much autonomy as they can.”


To become clinically integrated — which would allow the IPA to negotiate with payers, as North Shore-LIJ does — the doctors must have EHRs. So its members have agreed that, within six months, they will either have EHRs or have plans to get them, Prince says. At that point, the IPA will start to build the infrastructure for clinical integration, following the Federal Trade Commission’s guidelines that have allowed other IPAs and PHOs to bargain with payers.


The government incentives for meaningful use of EHRs will be a significant help to the practices in the IPA, Prince says. In addition, the IPA will provide some technical support to help physicians implement their EHRs and show meaningful use.


Where will the money for these activities come from if the IPA isn’t affiliated with a hospital? Prince says the IPA is in discussions with Empire Blue Cross Blue Shield and other payers. He suggests that the plans might be willing to kick in some extra funds to help the IPA become clinically integrated with the prospect of lowering overall costs down the line. Later on, if the IPA’s added value brings in enhanced payments, he says, part of that extra money could finance the IPA’s operations.


So far, Prince has been pleasantly surprised by the local payers’ interest in working with the IPA. He speculates that their interest might be prompted by their inability to limit cost increases from North Shore-LIJ, which has negotiated “very big rates… If they give us something extra and help to avoid that, I think that’s attractive to them.”


Meanwhile, Prince doesn’t rule out a future agreement with a hospital to form an ACO. “Remaining a free agent and seeing what the best fit is for us could be our advantage. If we grow and become a little more attractive, it might put us in a better position to negotiate a deal with a hospital or health system down the road.”

The Physician's Place in the ACO

This is a nice, thoughtful piece by Philip Betbeze today in HealthLeaders Media... "The Physician's Place in the ACO"

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"ACOs will include confederations of doctors, specialists, and hospitals working together to administer payments, determine quality and safety benchmarks, measure performance, and distribute shared savings, according to a June 2010 report from the American Hospital Association. Still, as we enter a four-year transition into new payment methodologies on which long-term strategic decisions must be made, organizations are left with making little more than educated guesses about how they might become an ACO.

Amid all this uncertainty, one thing does seem certain: The physician will play a key part—perhaps the key part—in whether such organizations are ultimately successful at removing waste from the healthcare payment system."

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I encourage everyone to read this article and stay up to date with this important topic. It remains to be seen how the ACO movement will unfold and what role Beacon IPA will play. But although there is a great bit of uncertainty, there is also the potential for a great opportunity.