An ACO is a group of health care providers who come together to say, “These are our patients. We are responsible for the cost and quality of their health care.” Today, amid the growing coronavirus crisis, that level of accountability means more than ever.
Creating a strong physician-patient relationship means that, as a patient, you don’t have to search the web for a doctor or medical advice. You have a doctor who knows you and who wants you to call them first — and do call them first right now.
For some health care providers, being accountable for the total cost of care in the middle of a pandemic may be causing a little extra stress right now. We want to allay your fears so you can focus on the needs of your patients.
The Medicare Shared Savings Program made a huge leap forward in 2018 when CMS adopted a policy of using mostly regional trends to set benchmarks. We advocated for regional trends (for years) because we knew that health care cost trends vary by community.
The cost implications from COVID-19 will be different in Louisiana than in Washington or New York. By using regional trends, the ACO in Louisiana will have a different update to its benchmark than the ACOs in Washington or New York. This is a huge improvement in the program that provides protection for savings and protection from losses.
CMS Adjustment for Extreme Circumstances
While the use of regional trends gives us much more confidence in ACO benchmarks, it’s still too early to know whether the program will successfully account for all of the varying effects of the coronavirus. Thankfully, CMS also has in place policies for extreme circumstances.
For example, if providers in an ACO were to differ significantly from their region’s experience because they have a unique patient population, or because the hospital next door or nursing facility got hit especially hard, CMS can override the regulations and protect that ACO individually from losses.
The improvements in the design of the program, combined with a fail safe that can be used in extraordinary circumstances, allow us all to focus on the needs of our communities even as we retain accountability for the cost and quality of care received by our patients.