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A Primer on Accountable Care Organizations. Raymund C. King, MD, JD, FICS Law Offices of Raymund C. King, MD, JD, PLLC Plano, Texas TASCS 2013 Annual Meeting – Houston, TX November 8, 2013. Historical and Projected Number of Medicare Beneficiaries and Number of Workers Per Beneficiary.

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A primer on accountable care organizations

A Primer on Accountable Care Organizations

Raymund C. King, MD, JD, FICS

Law Offices of Raymund C. King, MD, JD, PLLC

Plano, Texas

TASCS 2013 Annual Meeting – Houston, TX

November 8, 2013


Historical and projected number of medicare beneficiaries and number of workers per beneficiary
Historical and Projected Number of Medicare Beneficiaries and Number of Workers Per Beneficiary

Number of Beneficiaries (in millions)

Number of Workers Per Beneficiary

SOURCE: 2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.


The patient protection and affordable care act ppaca
The Patient Protection and Affordable Care Act (PPACA) and Number of Workers Per Beneficiary

  • Enacted March 23, 2010

  • Signed into law March 30, 2010

  • Estimated Cost of Implementation = $940 M in first 10 years


Accountable Care Organization and Number of Workers Per Beneficiary

THE BASICS


Aco requirements
ACO Requirements and Number of Workers Per Beneficiary

“Groups of providers that have established structures for reporting quality and cost of health care, leadership and management that includes clinical and administrative systems; receiving and distributing shared savings; and shared governance.”


Aco requirements1
ACO Requirements and Number of Workers Per Beneficiary

  • Willing to become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it.

  • Minimum three-year contract.

  • Sufficient primary care providers to have at least 5,000 patients assigned.

  • Processes to promote evidence-based medicine, patient engagement, and coordination of care.

  • Ability to demonstrate patient-centeredness criteria, such as individualized care plans.


How is a benchmark determined for the aco
How is a benchmark and Number of Workers Per Beneficiarydetermined for the ACO?


Physician survival in an aco
Physician Survival in an ACO and Number of Workers Per Beneficiary

  • Decrease Cost AND Increase Quality

  • Physician alignment

  • Data sharing

  • Patient Care Coordination

  • Insurance contracting

  • Overhead expense controls

  • Risk sharing


Cms aco models
CMS ACO Models and Number of Workers Per Beneficiary


The shared savings program
The Shared Savings Program and Number of Workers Per Beneficiary

  • Improve beneficiary outcomes and increase value of care

  • Promote accountability for the care of Medicare FFS beneficiaries

  • Require coordinated care for all services provided under Medicare FFS

  • Encourage investment in infrastructure and redesigned care processes

  • The Shared Savings Program will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first.


How are beneficiaries assigned to an aco
How are beneficiaries and Number of Workers Per Beneficiaryassigned to an ACO?


How are patients assigned to the aco
How are patients and Number of Workers Per Beneficiaryassigned to the ACO?

Providers sign agreement to participate with an ACO

PCPs must be exclusive to one ACO

Specialists can be part of multiple ACOs

Patients are assigned to their PCP based on the majority of their outpatient E&M visits

These are YOUR existing patients and those of your other ACO members


Measuring Quality Improvement and Number of Workers Per BeneficiaryThe amount of shared savings received by an ACO is linked to its performance on quality measures.

Quality Measures:

  • Patient/caregiver experience of care

  • Care coordination

  • Patient safety

  • Preventive health

  • At-risk population/Frail elderly health


The Bottom Line and Number of Workers Per Beneficiary


Questions? and Number of Workers Per Beneficiary


The end

THE END and Number of Workers Per Beneficiary

Raymund C. King, MD, JD [email protected]

(972) 381-2792


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