Caduceus and Money
Image Courtesy FlickrCreative Commons, nffcnnr

By Rose Hoban

The federal Centers for Medicare and Medicaid Services announced Tuesday the approval of 123 new accountable care organizations across the country, with six of them in North Carolina.

The organizations serving North Carolina include:

  • Bayview Physicians Group, based in Norfolk, VA, with locations in northeastern N.C.
  • Carolinas ACO, based in Charlotte, with locations in N.C., S.C. and Virginia
  • CaroMont, based in Gastonia, with locations in N.C and S.C.
  • Central Virginia Accountable Care Collaborative, based in Virginia, with locations in N.C.
  • Duke Connected Care, based in Durham, serving N.C.
  • WakeMed Community Care, based in Raleigh, serving N.C.

An Accountable Care Organization is a way of organizing the delivery of health care services that ties predetermined quality measure and patient outcomes to reimbursement for care. If the organization is successful in improving efficiency as well as the care and health of patients, the care organization keeps extra reimbursement from federal programs such as Medicaid and Medicare.The arrangement puts doctors’ groups and hospitals at more “risk” in that they have to prove what they’re doing is efficient and effective in order to get paid.

That’s a big change from prior payment schemes, where doctors and hospitals received payment simply for performing services.

Since passage of the Affordable Care eight other ACOs have been formed in North Carolina, Tuesday’s announcement brings the total to 14.

Below is a press release from CMS, sent Dec 24.

Doctors, hospitals and other health care providers have formed 123 new Accountable Care Organizations (ACOs) in Medicare, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States, Health and Human Services Secretary Kathleen Sebelius announced today.

Doctors, hospitals and health care providers establish ACOs in order to work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. Since passage of the Affordable Care Act, more than 360 (ACOs) have been established, serving over 5.3 million Americans with Medicare.  Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs share with Medicare any savings generated from lowering the growth in health care costs when they meet standards for high quality care.

“Accountable Care Organizations are delivering higher-quality care to Medicare beneficiaries and are using Medicare dollars more efficiently,” Secretary Sebelius said.  “This is a great example of the Affordable Care Act rewarding hospitals and doctors that work together to help our beneficiaries get the best possible care.”

The ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) evaluates ACO quality performance using 33 quality measures on patient and caregiver experience of care, care coordination and patient safety, appropriate use of preventive health services, and improved care for at-risk populations.

The new ACOs include a diverse cross-section of healthcare providers across the country including providers delivering care in underserved areas. More than half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries.  Approximately one in five ACOs include community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities.

Affordable Care Act provisions have a substantial effect on reducing the growth rate of Medicare spending.  Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, and this trend has continued into 2013. Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.

The next application period for organizations interested in participating in the Shared Savings Program beginning January 2015 will be in summer 2014.

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3 replies on “CMS Announces Six New N.C. Accountable Care Organizations”

  1. Where did you find a list of who is in the ACO’s to know that there were NC docs in VA ACO’s?

  2. I agree also. Why tell us they formed this organization for our betterment and then not let us see who all is in this WakeMed ACO? How are we going to know if all our doctors are in it?

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