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."