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

Margaret Dick Tocknell, for HealthLeaders Media , April 18, 2012

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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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.




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