1 / 11

Accountable Care Organizations

Accountable Care Organizations. Who should you partner with? The goal of this presentation is to share some tips with small physician practices being approached by larger hospital systems to form accountable care organizations . Background.

hank
Download Presentation

Accountable Care Organizations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Accountable Care Organizations Who should you partner with? The goal of this presentation is to share some tips with small physician practices being approached by larger hospital systems to form accountable care organizations

  2. Background • Accepted Reality – Consolidation in the healthcare industry • Insurers seek to buy physician practices • Larger hospital systems partner with smaller practices – typically in the form of leased provider agreements • Still dynamic environment • Although many ACO rules are being laid, they are changing often, keeping the environment dynamic

  3. When partnering bear in mind … • Under the PPACA, hospitals are under pressure to form ACOs. Physicians have no reason to believe that their bargaining power is low. • However, to get the most out of any partnership and make it a win-win situation, many factors need to be addressed.

  4. When partnering bear in mind … • Physicians should aim to get some ‘tangible’ benefit from the partnership which does not lose much value even if the external environment changes again or the partnership does not work out.

  5. Before considering ANY partnership • Perfuming the pig: • Calculate RVUs for all the services provided at your facility – Ample information available on the AMA website or physicianspractice.com • Assess the strengths and weaknesses of your practice; look for a complementing partner; analyze partner proposals in the light of ‘your need’

  6. 3. Have an independent consultant determine the fair market value the practice – the space, equipment and the non-clinical services. 4. Keep an eye on the ACO pilots for their successes and failures – Learn from others’ mistakes – • In New York area – Bronx Accountable Healthcare Network (BAHN) servicing the area of Bronx and lower Westchester County.

  7. Simple questions to ask yourself • How much of the expected higher reimbursement will trickle back into the practice? How? • How good is the other party at collecting self-pay payments? • Can we include a yearly re-open clause in the contract? • What can our practice learn from the hospital system? • Will there be a culture change in the way my practice is run? Will it be beneficial?

  8. Lease versus Sell • Out-right sale of a practice is generally not recommended • Leased provider agreements are more common and serve most needs

  9. Billing Services • If physician practice has had in-house billing, they should maintain that for the following reason. • Maintaining good over-sight over the financial aspect • Immediate access to financial informationwhich helps to analyze the connection of billing to reimbursement.

  10. In conclusion, • Like any other business partnership • Focus on learning what the other party does best • Share what you do best and how • Frequent communication is a cornerstone • Maintain healthy transparency • Be customer focused at all times

  11. A word about me Urvi Shah B. P. Th (India) M. B. A. – M. H. A. (USA) I am no expert, I just read a lot. http://www.linkedin.com/in/ushah1

More Related