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Crystal Run's ACO Puts Physicians in Driver's Seat

 |  By Margaret@example.com  
   April 18, 2012

Crystal Run Healthcare learned last week that it is among 27 healthcare organizations selected to participate as an accountable care organization in the federal Medicare Shared Savings Program.

The 250-physician medical group, based in Middletown, NY, doesn't match the ACO profile first presented by the Centers for Medicare & Medicaid. Back in April 2011 it was expected that hospitals would take the lead on ACOs, and physicians would be the carrot to pull in the patients for the hospitals.

A funny thing happened, though. Physician practices took a look at the ACO arrangement, connected the dots, and began to wonder why they needed the hospitals. A primary care network controls the flow of patients to hospital-based specialists as well as to the ancillary services offered by the hospitals. So why not form their own physician-based ACO unencumbered by an exclusive relationship with one hospital?

That's exactly how Crystal Run Healthcare plans to operate its MSSP ACO, explains Scott Hines, MD, co–chief clinical transformation officer at Crystal Run.

By not having a particular hospital as part of its ACO, the physicians at Crystal Run are free to send their patients to whichever hospital that provides the best quality at the lowest cost for a particular ailment or procedure. "It frees us up, at least in some way, to control the cost of the hospital," says Hines.

"Competition is good. We can tell hospitals that we are willing to increase our business there if they are able to prove to us that they are high-quality facilities that also have lower rates than their competitors."

The physician group contracts with 4 hospitals in Orange and Sullivan counties, which are located about an hour northwest of New York City. It also contracts with an academic medical center in Westchester County as well as one in New York City.  

Crystal Run has for years been working on two parts of the popular "triple aim" for healthcare: better care and better health. The physician group's 15 sites are linked by a single electronic medical record system, and it has invested in patient care managers for more than 10 years. That hasn't been a reimbursable expense under fee-for-service arrangements, but Hines expects that with the ACO the group will begin to reap the financial benefits of having an established care management model in place.

Hines says cost, the third leg of the triple aim, hasn't been addressed because "frankly we haven't had to until now." He explains that there hasn't been a lot of Medicare Advantage or risk-based contracting in the group's service area compared to other parts of the county, but that's beginning to change.

Crystal Run will participate in track one of the MSSP. There is the potential for reduced revenues and reduced bonuses if the group doesn't meet patient quality and outcome goals.

The preparation and approach Crystal Run Healthcare is taking in developing its ACO sets it apart from the findings of the 2012 HealthLeaders Media Accountable Care Organizations Survey.

According to our survey of healthcare leaders, many remain uncertain about the value of ACOs to their organization, many are operationally unprepared for ACOs, and financial risk remains a potential stumbling block for ACOs.

Hines says Crystal Run views the Medicare ACO as an extension of its existing business model. The investments in EMR and care management are the groundwork for an ACO-type of coordinated care. "We're not going to change very much in order to be successful in MSSP. May be just may some tweaks."

In a couple of areas Crystal Run will need work to reduce costs, such as making sure that best-practice guidelines are being followed in the treatment of chronic diseases and that unnecessary tests aren't ordered. The physician group has already piloted a program to analyze the wide variations in the total cost of care within its own practice for illnesses such as diabetes, asthma, and hypertension. The conclusion: Costs are reduced when physicians follow best practices. The group is developing a process to make sure physicians are up to date on all care guidelines.

Crystal Run is also developing a care team program to help prevent unnecessary hospital readmissions. Hines says it will have applications not only for the ACO but for any risk-based contract. The program is an extension of the physician group's existing discharge team that works with hospitals in coordinating patient discharges.

Hine says he is unconcerned by the political maelstrom surrounding the Patient Protection and Affordable Care Act. "The MSSP is only about 30 pages of the law. I think CMS will continue to pursue this. Really, the payment method hasn't changed but now we'll tally things up at the end of the year and see where we stand."

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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