Pathologists and clinical laboratory administrators have an opportunity to add value to physicians who are transitioning to new ACO model

It is good news for advocates of accountable care organizations (ACOs). Since the beginning of 2012, an ever-growing number of provider organizations have signed up to participate in Medicare ACO contracts.

This steady increase in the number of hospitals and health systems participating in Medicare and private payer ACOs will have at one interesting consequence. It means that the clinical laboratories will be part of the clinical service mix for the ACOs operated by the hospitals and health systems.

Number of New Medicare ACOs Is Growing at an Impressive Rate

Medicare officials are pleased at the strong number of ACO sign-ups since the start of the year. This is despite early physician reluctance to adopt the model. (See Dark Daily, “AMA Survey Reveals That Physician Interest Lags In ACO Participation”.)

During the first round of contracts earlier this year, 32 provider organizations struck ACO deals with the agency, a story in Modern Healthcare (MH) reported. This was in addition to the roughly half dozen medical groups that had pioneered the Medicare ACO model. Since that time, the number of Medicare ACO contracts has quadrupled.

Throughout the course of 2012, the number of provider organizations contracting with Medicare to operate an accountable care organization (ACO) has increased at a steady rate. In July, Medicare officials announced another 88 ACOs, bringing the total to more than 153 organizations. The map above shows the distribution of ACOs throughout the United States. The size of the circle indicates the number of physician participants in ACOs in that region. (Map copyright by Robert Rowley MD.)

Throughout the course of 2012, the number of provider organizations contracting with Medicare to operate an accountable care organization (ACO) has increased at a steady rate. In July, Medicare officials announced another 88 ACOs, bringing the total to more than 153 organizations. The map above shows the distribution of ACOs throughout the United States. The size of the circle indicates the number of physician participants in ACOs in that region. (Map copyright by Robert Rowley MD.)

“[W]e have a very strong [ACO] program that exceeds our goals that we had for the first year,” declared Jonathan Blum, Deputy Administrator and Director for the Center for Medicare at the Centers for Medicare and Medicaid Services (CMS).

The agency approved an additional 27 organizations in April. But that was just the start. Within recent weeks, Medicare approved an additional 89 organizations. Blum added that another 400 provider organizations will apply for the next round of ACO contracts.

Medicare  to Resolve “Hiccups” in ACO Data Distribution

To share in the cost savings promised by the ACO model, healthcare providers must hit certain performance measures, the MH writer noted. However, in order to hit those measures, they are dependent on Medicare to provide the necessary data in a timely fashion. And here is where the first glitch has become obvious.

In the first wave of ACOs, Medicare has found it difficult to get the needed information to providers. “While we have a willingness to share data, it’s not always as simple as we had hoped,” acknowledged Marilyn Tavenner, Acting Administrator for the CMS.

Blum confirmed that Medicare is having problems supporting ACOs in at least two areas: 1) the agency’s ability to distribute the necessary data; and 2) providers’ ability to accept and use the information.

The MH story offered this illustration of the hitch. ACOs are responsible for managing care for a specific group of patients. The patients are identified by which doctors they see. Medicare had agreed to furnish the crucial patient lists to providers upfront. However, the agency’s data transmission failed to identify which patients visit which doctors.

Providers are experiencing challenges with the program beyond the delay of data from the CMS, MH noted. These include:

  • determining how to format, store, and use the data from Medicare;
  • dapting electronic health records in order to report new measure to Medicare; and,
  • coordinating patient care with area hospitals outside the ACO upon hospital admission and discharge.

ACO Model Success Will Require Patience and Fortitude

Whether the ACO model actually delivers on its promise of producing improved care at lower cost remains to be seen. “This is a big experiment,” declared David T. Page, M.D., Director of the Accountable Care Coalition of Syracuse (ACCS). This 65-physician practice operates 30 locations in Central New York. ACCS lacked the information technology resources needed for a Medicare ACO. It teamed up with an insurance company that had the necessary infrastructure and negotiated a contract with the agency.

“Everybody needs to be patient,” Page stated, referring to physicians, patients and Medicare. “I just hope that everybody’s got the intestinal fortitude so that we can change at a pace that we can accommodate.” Page added that success of the ACO model will require that Medicare set realistic goals and provide education.

Pathologists and clinical laboratory managers whose medical laboratory organizations are supporting ACOs can expect to encounter some glitches as Medicare’s ACO program grinds forward. At the same time, savvy laboratory scientists will take the opportunity to help smooth the transition for office-based physicians who will be paying greater attention to ordering medical laboratory tests more appropriately.

—Pamela Scherer McLeod

Related Information:

Medicare’s new ACOs tripped up by data delays

Next Steps for ACOs

Feds tap Syracuse doctors group to improve care and lower cost for Medicare patients

Dark Daily, “AMA Survey Reveals That Physician Interest Lags In ACO Participation”

Dark Daily, Accountable Care Organizations (ACOs) Expected to Encourage Appropriate Use of Clinical Pathology Laboratory Tests”

The Dark Report: Healthcare Reform and Laboratory Testing

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