Accountable Care Organizations and Medicare

[Eagle43]

I got a call from my doctor's office, who scheduled both me and my wife for an office visit. I asked why, and the nurse said: "It's about ACO." I have googled this and mostly find stuff relating to the physician's costs, organizations, etc.

Accountable Care Organizations (ACO) - Centers for Medicare & Medicaid Services

Question : Has anyone had any experience with this? I have Tricare and Medicare. I would like to be knowledgeable before I go for the visit next week? I'm cynical and expect this to get into my pocket.

 

[Htown Harry]

I'm not speaking from experience or with industry-specific knowledge, but I wouldn't worry about it too much.

Following the link you provided, I found out that doctors and hospitals teaming up to form ACO's are eligible for extra payments above the Medicare fee-for-service tables. Some of the performance-based standards affecting ACO patients (vs. back-office efficiencies) are coming into effect in the next few months.

This document describes some of the measures.

http://www.cms.gov/Medicare/Medicar...ram/Downloads/ACO-NarrativeMeasures-Specs.pdf

This is the basic business deal for your doctor and his ACO:

Medicare providers who participate in an ACO in the Shared Savings Program will continue to receive payment under Medicare Fee-For-Service rules. That is, Medicare will continue to pay individual providers and suppliers for specific items and services as it currently does under the Medicare Fee-For-Service payment systems. However, CMS will also develop a benchmark for each ACO against which ACO performance is measured to assess whether it qualifies to receive shared savings, or for ACO’s that have elected to accept responsibility for losses, potentially be held accountable for losses. The benchmark is an estimate of what the total Medicare Fee-For-Service Parts A and B expenditures for ACO beneficiaries would otherwise have been in the absence of the ACO, even if all of those services were not provided by providers in the ACO. The benchmark will take into account beneficiary characteristics and other factors that may affect the need for health care services. This benchmark will be updated for each performance year within the agreement period.

...if an ACO meets quality standards and achieves savings and also meets or exceeds a Minimum Savings Rate (MSR), the ACO will share in savings, based on the quality score of the ACO.

Possible impacts: more patient satisfaction forms to complete and more emphasis on keeping up with several specified innoculations and health screenings.

 

[MichaelB]

The call and visit sounds like they scheduled a Medicare wellness exam. This is a new yearly exam and assessment where the physician, in addition to the check-up, asks a series of questions in an effort to determine if there are any aspects of your lifestyle that might be a risk to your health. They also schedule appropirate preventive screenings. It applies to everyone on Part B for one year or more and can be helpful.

 

[Eagle43]

Thanks for replies. The visit reminded me of military doctor visits. They wanted to give me a pneumonia shot. I declined. They told me my bmi was 6 tenths too low! Eat more protein I was instructed. I had a physical a couple of months ago; got a colonoscopy and had a stress test. Passed everything. Oh, asked if I had a flu shot recently. Not in 30 years, I replied. Also asked if I'm depressed. No. But I might be when they insist I get a flu shot this fall. No indication of any fee increases yet. I asked what an ACO was all about and they said it's how the doctor ensures he gets his Medicare money. Overall, the visit was filling squares on my healthcare records to pass a possible Medicare evaluation of the doctor.

 

[Buckeye]

My mom got the questionnaire at her last visit. I wondered what the heck it was all about. I think she wanted to tell them to mind their own business. I know I did.

I asked the 12-year old behind the counter what would happen if my mom didn't want to fill it out? She looked at me like I had 3 heads.

 

[Gatordoc50]

Sounds like they are allowing patients to express their autonomy by rejecting proposed preventative care. I would guess that at some point the patient will then be responsible for the consequential costs of bad outcomes for denying care. As it should be, IMO.

 

[Buckeye]

Sounds like they are allowing patients to express their autonomy by rejecting proposed preventative care. I would guess that at some point the patient will then be responsible for the consequential costs of bad outcomes for denying care. As it should be, IMO.

I guess I didn't see the questionnaire as preventative care driven. It was very intrusive IMO. My family takes personal responsibility for our health. Maybe the questionnaire would work better from someone who has handed over responsibility to their doctor.

 

[Gatordoc50]

I guess I didn't see the questionnaire as preventative care driven. It was very intrusive IMO. My family takes personal responsibility for our health. Maybe the questionnaire would work better from someone who has handed over responsibility to their doctor.

Fair enough. But I think patients should direct their anger over the questionnaire to those who wrote it and incentivize or require it's use.

 

[Buckeye]

Fair enough. But I think patients should direct their anger over the questionnaire to those who wrote it and incentivize or require it's use.

I also didn't care for the "Here, fill this out" and the "just do it because I told you to" attitude I received when I asked "why is this info being collected?"

 

[Gatordoc50]

They should be more polite. No excuse for that. Hope the DMV attitude isn't a sign of things to come.

 

[Buckeye]

They should be more polite. No excuse for that. Hope the DMV attitude isn't a sign of things to come.

Sign of things to come? No. I find this to be typical medical provider office attitude which, other than cost and quality of life, is the main reason I have been motivated to stay healthy and learn as much as I can about what can go wrong with me and why. My tendency to ask "why" has never seemed to mesh with their operating philosophy.

 

[Eagle43]

Sounds like they are allowing patients to express their autonomy by rejecting proposed preventative care. I would guess that at some point the patient will then be responsible for the consequential costs of bad outcomes for denying care. As it should be, IMO.

I have heard that if and when Medicare won't pay or pays less because something was refused, the patient well be deemed non compliant and dropped by the doctor. This is gossip,and may be untrue. I hope so, because I take good care of my health and hate unnecessary doctor visits.

 

[Buckeye]

I have heard that if and when Medicare won't pay or pays less because something was refused, the patient well be deemed non compliant and dropped by the doctor. This is gossip,and may be untrue. I hope so, because I take good care of my health and hate unnecessary doctor visits.

I definitely got the impression that it was "my way or the highway" and that my mom could find herself a new doctor if she didn't feel like filling out the paperwork. Filling out the paperwork was "office procedure."

 

[Gatordoc50]

Sign of things to come? No. I find this to be typical medical provider office attitude which, other than cost and quality of life, is the main reason I have been motivated to stay healthy and learn as much as I can about what can go wrong with me and why. My tendency to ask "why" has never seemed to mesh with their operating philosophy.

That's not typical in my experience. In fact I've never been treated with anything but respect.