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



It's not only hospitals that see value in accountable care structures. Physician groups like Crystal Run Healthcare can use their ACO designation to encourage hospitals to compete on cost. 



1 comments on "Crystal Run's ACO Puts Physicians in Driver's Seat"
Mike Barrett (4/19/2012 at 7:22 AM)

Looking at the list of the most recently approved MSSP contractors i.e. Medicare ACOs and even the Pioneer ACOs, one can see a distinct vein of physician leadership and engagement. What is coming to the forefront rapidly is the impact of physician exclusivity to a particular program and its effect on market share for specialists, PCPs, and ultimately IPAs, payors and other intermediaries and vendors to the ACO space. 3% of non MA patients are already assigned and as of July 1, this could jump dramatically an again on 1/1/2013. For example, in the MSSP "Primary Care Services" are defined by CPT code vs. specialty of the physician. This means any/every physician that signs on and who bills a 9921x is considered to have delivered PCP services and therefore backs in to exclusivity. This is reasonably straight forward for PCPs, it is another thing completely for specialists. To support an effort, that may not contain the specialists entire referral base, the specialist could invest into the ACO yet not sign a participation agreement. Counter intuitive, but possible and indeed probable where physician communities are more diverse. Their role on the BoD would be that of investor vs. provider. More interest comes in where the ACO is [INVALID]ing a vendor for a particular service - the PCP and now growing specialty exclusivity and consistency needs/demands/requirements changes the point of sale for many vendors. Stay tuned the MSSP program is just starting to reshape the landscape. mbarrett@ascendentcare.com