Frequently Asked Questions
01 As a healthcare provider, must I participate in an ACO?
Participating in an ACO is purely voluntary for providers. We realize different organizations are at different stages in their ability to move toward an ACO model. We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to participate in and begin this work, no matter your organization’s stage.
02 What Is Coordinated Care?
Coordinated Care means that all the healthcare professionals work together to assure that the patient gets the right care at the right time. Healthcare professionals will communicate with each other, with the goal of preventing medical errors and avoiding needless repetition of services.
03 How does an ACO help Physicians coordinate care?
Health care providers have reported that a barrier to improving care coordination is the lack of information. While they may know about the services they provide to the beneficiary, they are unaware of all other services provided to the beneficiary. To better treat Medicare fee-for-service beneficiaries and to coordinate their care, ACOs will receive Medicare health information about their Medicare fee-for-service beneficiaries from CMS, regardless of their location of care. Before doing so, ACOs must notify a beneficiary in writing that it will request the beneficiary’s health information from CMS. ACOs must allow beneficiaries to decline having their health information shared with the ACO.
Declining to have this information shared, however, does not affect the provider’s participation in the ACO, the care that is delivered by the provider to their Medicare Fee-For-Service Beneficiaries or CMS’ use of the beneficiaries data for the purpose of assessing ACO’s performance on quality or cost measures (the ACO will not receive the data.)
04 How does Shared Savings work?
Medicare will continue to pay individual providers and suppliers for services as it currently does under the Medicare Fee-For-Service payment systems. Doctors ACO is participating in the risk-free CMS Shared Savings Program. If the ACO lowers its health care costs while meeting performance standards on quality of care and putting patients first, Doctors ACO and its physicians will assume no downside risk.
05 Who is responsible for the Doctors ACO Operations Cost?
Doctors ACO management team will be investing substantial sums in the range of $1 million to $1.5 million in the operating expenses for the first 22 months (first 12 months plus another 10 months until the first shared savings check is received).
06 What are the requirements for a Physician's participation in Doctors ACO?
Commitment of Development Funds - $1,000
No other obligation or risk.
Local physicians participation in governance.
Can withdraw at any time - With no penalty associated.
07 How will the Shared Savings will be distributed?
Doctors ACO Management Company will take 30% profit sharing and 70% will be shared within Doctors ACO physicians. After the expenses the profit will be shared between the PCP (80%) and Specialist (20%).
40% based on Assigned Beneficiaries
40% based on performance (Shared Savings)
08 Who has the ownership of Doctors ACO?
Doctors ACO Management Company has 30% ownership and 51% voting Governance/Operations.
Doctors ACO Physicians Members have 70% ownership and 49% voting Governance/Operations.
09 I understand that each physician has to contribute $1,000 to join, but will I be paying more later on?
Doctors ACO physicians will only be investing $1,000 each. Not a penny more. In fact, Doctors ACO management team will limit the amount of operating expenses charged against shared savings. They will charge $6 per month per member for up to 5,000 beneficiaries and $4 per member over 5,000. Although, operating expenses will likely exceed $6/$4 per member, the excess will not be charged to Doctors ACO. Management team will absorb noperating costs over $6/$4 per member.
10 Who has the power to control the Doctors ACO?
The local ACO physicians will make decisions regarding the management of the ACO physicians. The local ACO physicians can decide on the physicians that will sit on the Board, various Committees and the selecting of a Medical Director. Also, the local physicians can decide on what grounds the physicians can be terminated from the ACO.