To empower patients and provider participation in accountable care organizations (ACOs), Centers for Medicare & Medicaid Services (CMS) is attempting hard by automating the process to pair sufferers with doctors participating in the care models.
A Medicare beneficiary can go to a website in the coming weeks that consists of their enrollment information and list his / her primary care doctor. If that doctor is in an ACO, they would be assigned to both that provider and their ACO initiating next year.
“Accountable Care Organizations (ACOs) have informed us that they prefer to know with more certainty at the start of the performance year what beneficiaries the CMS will hold them accountable for, “Dr. Terri Postma, a medical officer in the Center for Medicare stated during a meeting on the day of Wednesday with HHS' Advisory Panel on Outreach and Education (APOE) that ACOs need to know at the beginning of the performance year which beneficiaries they are accountable for.
About the current process, providers complain in which sufferers are significantly assigned retroactively to ACOs. That means the Centers for Medicare & Medicaid Services (CMS) will tell a doctor at the end of the year which of their patients' care will be judged to evaluate success in raising quality of care while decreasing costs.
The agency does this to make sure that doctors do not select only their healthiest sufferers to participate in their ACOs.
The concept of electronically pairing beneficiaries and ACOs was 1st proposed in the 2017 physician pay rule released previous year.
The news was greeted by providers at that time period with a mixed reaction. They supported knowing earlier which sufferers would be engaged in ACOs but they wondered whether patients could conveniently give the information.
For instance, the AAFP noted in an August comment letter that that Medicare beneficiaries might not have access to a computer or might not comprehend how to navigate the site. Having an 800 number as a backup would not assist older adults that are hard of hearing.
The group emphasized the CMS to consider 2 options. Either doing a small pilot program to see if the procedure would work or use claims submitted by providers to assign beneficiaries.
Postma was seeking the help of APOE on the day of Wednesday to get beneficiaries to log on to MyMedicare.gov and choose a provider. 30 percent of Medicare beneficiaries have been estimated by Postma using the site now.
The group recommended the CMS develop a strategy to inform consumers of the benefits of ACOs and the requirement for them to pick their own doctor.
Following the meeting, Jeff Spight, the president of Collaborative Health Systems, a division of Universal American that operates ACOs stated that he was not sure the new pairing initiative would be victorious.
Spight said, “An earlier ACO participation campaign that inquired Medicare enrollees to choose a doctor via a mailed letter fell flat as beneficiaries did not comprehend the notices being sent to them”.
Currently, 480 ACOs are participating in the Medicare Shared Savings Program overseeing the care of 9 million beneficiaries. Almost, 55 million individuals are enrolled in Medicare.