Florida a frontrunner in the model makeover, especially physician-led
When Becker’s Hospital Review published “80 Accountable Care Organizations (ACOs) to Know” in April, Florida dominated the alphabetically-listed crop with five. It was a surprising statistic, especially since many states in the South weren’t represented, such as Alabama, Arkansas, and South Carolina.
However, Florida has been proactively developing commercial (usually hospital-led) and Medicare ACOs (typically physician-led) in the past year. Arguably, all five ACOs on the list are physician-led. However, two ACOs are corporate-developed. Three notably physician-led ACOs were developed with the assistance of Florida Accountable Care Services (FACS), based in Winter Park.
The Florida ACOs on the elite list include:
Florida Physicians Trust, also based in Winter Park. Named one of the original 27 ACOs to participate in the Medicare Shared Savings Program, the physician-led ACO is expected to serve about 16,500 beneficiaries. This diverse group of independent physicians includes doctors of medicine (MD) and osteopathic medicine (DO), who plan to focus on care coordination, team-based care, and improved provider-patient communication.
JSA Medical Group, based in Saint Petersburg. In the last quarter of 2011, Centers for Medicare and Medicaid Services (CMS) named the group of 34 primary care practices in the greater Tampa Bay and Orlando metro areas, that also has affiliations with more than 50 primary care practices, one of the first 32 Pioneer ACOs in the country. All total, the ACO includes 184 primary care physicians and roughly 1,800 specialists.
Primary Partners, based in Clermont, home of cardiologistSandeep Bajaj, MD, founder of Florida Cardiology. In April, CMS named the physician-led ACO among the first 27 ACOs to participate in the Medicare Shared Savings Program. It’s among few that received advance Medicare implementation funding. Expected to serve about 7,500 beneficiaries, Primary Partners includes participating physicians from four Florida counties – Lake, Orange, Osceola and Polk – and will offer clinically integrated patient-centered care while primary care physicians alternately operate their independent practices.
ProMed Alliance, based in Dade County. Peer Review Mediation & Arbitration, a medical services business development company, formed the ACO as a subsidiary in March. The first of 50 PRMA and ProMed plans to develop across the country over the next five years, this ACO includes some 15 primary care physicians, 20 specialists, and an advanced diagnostic and surgery center.
West Florida ACO, based in Trinity. Three months ago, CMS named the ACO among the first 27 participants in the Medicare Shared Savings Program. Comprised of more than 30 primary care physicians and specialists who focus on care coordination for geriatric patients, internist Jayadeva Chowdappa, MD, leads the ACO, which is expected to serve more than 10,000 Medicare beneficiaries.
RELATED STORY: FACS Plays Vital Role in Florida’s Physician-Led ACO Formation
Florida’s early success in accountable care organization (ACO) formation, particularly physician-led, may be attributable to Florida Accountable Care Services (FACS), a Winter Park-based company that, in conjunction with its partner organizations Medical Association (FMA) and the Florida Osteopathic Medical Association (FOMA), and multiple Independent Physician Associations (IPAs), researches and develops the ACO platform for physicians.
“The primary goal is to educate all physicians in Florida on the Accountable Care Organization and provide them with the actual tools they’ll need to succeed in the shifting landscape of health reform,” said FMA general counsel Jeff Scott (no relation to Gov. Rick Scott), adding that FACS’ mission clearly aligns with FMA’s “set of principles for how ACOs should develop and operate.”
FACS has secured key partnerships with state and national commercial insurance providers and managed care organizations, and is actively pursuing Medicaid and Medicare contracts. Also on their team: prominent members of patient advocacy groups, health policy experts from around the state, physician assistant (PA) and nursing representatives, seasoned managed care and commercial insurance operators, legal and regulatory experts, and leading IT gurus.
Governed by Florida Physicians for Florida Physicians, FACS provides a diverse range of services in the development of ACOs, from educational support through its Florida ACO Learning Network, ACO Seminar Series, to participation in numerous healthcare meetings and events throughout the state. FACS has already presented more than 100 ACO educational seminars.
Nationally, it stands out as the only statewide-focused ACO learning network. Healthcare administrator Ivan Reyes and attorney Vikram J. Saini are listed officers in the foreign limited liability company filed Aug. 30, 2010, with Saini as the registered agent.
“The state medical association has been approached by other states to set this up as well,” said cardiologist Sandeep Bajaj, MD, founder of Florida Cardiology in Clermont, who was instrumental in establishing FACS.
The reason why FCAS was founded centers on this truth: “There’s no doubt the cost of healthcare is out of control, and the federal government is running out of money,” said Bajaj. “They had to come up with something that would make a difference. The ACO model is a monetary incentive that allows physicians to improve the quality of life for Medicare members, reduce the cost of healthcare spending, and improve the health of the entire population.”
Money saved reducing overall healthcare costs returns to ACO members, said Bajaj.
“We embarked on this journey to facilitate a venue for physicians to call the shots in the ACO movement,” he said.
Scott calls the ACO model “a dramatic new approach to healthcare.”
Many individuals and organizations view the changes in healthcare as further impediments by the government and large players in how physicians treat their patients; how patients will receive care; and how much everything will cost, he said. “Meanwhile, others view this as the last opportunity for physicians to wrestle back control of the healthcare system; to increase patients’ access to care; to be the driving force behind the increase of quality care received by patients; and resume their place as the rightful stewards of the system,” said Bajaj.
RELATED STORY: AMA Gives Thumbs Up to Physician-Led ACOs
The American Medical Association (AMA) has given its nod of approval to physician-led ACOs.
“Allowing physicians in all practice settings and sizes to participate increases the number of Medicare ACOs and maximizes the benefits for patients, physicians, taxpayers and the Medicare system as a whole,” said AMA President Peter W. Carmel, MD.
The physician-led component of ACOs will allow physicians “to build on existing physician-patient relationships,” he said. “This is critical to successfully improve the quality of patient care while reducing costs.”
Also, the Centers for Medicare & Medicaid Services (CMS) rules for the program allow for prospective assignment, so participating physicians know which patients will be in an ACO to calculate shared savings, while beneficiaries retain the right to choose physicians outside an ACO. (ACOs are being evaluated for shared savings from April 1 to Dec. 31, 2013.)
Groups have the opportunity to share in some of any savings after 12 months through an interim reconciliation process, said CMS spokesperson Ellen Griffith. Because CMS requires a time period to analyze claims and finalize results, the first interim payments should be sent to groups next summer or fall.