One physician, one ACO

by Frank Tiedemann on June 13, 2013

I find it surprising how few providers understand the CMS rule that physicians may join only one ACO. This applies to specialists as well as primary care physicians, no exceptions.

The implications for hospitals are fascinating and potentially devastating. That’s because the Medicare shared savings program is only available to hospitals and physicians who are members of an ACO. The shared savings bonus is potentially equal to half of the savings generated by members of an ACO. This promises to be worth tens of millions of dollars to ACOs across the country beginning in 2015.

So hospital CEO, ask yourself, are my key physicians in my ACO? Are the surgeons and other specialists who put the most profitable cases and patients in my hospital part of the ACO that I will share savings with? Or have my key physicians launched their own ACO without me? That’s an increasingly important choice physicians are making for themselves. It lets them capture and control 100% of the potential shared savings in Medicare ACOs.

If your key physicians own and control the ACO have they bothered to include your hospital? Or are you simply an expense they choose to control in order to claim the greatest possible Medicare shared savings? Or worse yet, have your key physicians joined your competitors ACO? Are they sharing savings with your competitor?

How will you answer these questions for your governing board and your medical staff? Does your healthcare system know about the choices you are making about a local ACO? Surely they are not telling you to wait until your physicians or competitors control the choice of who is in the dominant ACO in your community?

How long does forever last when physicians make their choices about joining an ACO?

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