Crystal Run Healthcare learned last week that it is among 27 healthcare organizations selected to participate as an accountable care organization in the federal Medicare Shared Savings Program.
The 250-physician medical group, based in Middletown, NY, doesn't match the ACO profile first presented by the Centers for Medicare & Medicaid. Back in April 2011 it was expected that hospitals would take the lead on ACOs, and physicians would be the carrot to pull in the patients for the hospitals.
A funny thing happened, though. Physician practices took a look at the ACO arrangement, connected the dots, and began to wonder why they needed the hospitals. A primary care network controls the flow of patients to hospital-based specialists as well as to the ancillary services offered by the hospitals. So why not form their own physician-based ACO unencumbered by an exclusive relationship with one hospital?
That's exactly how Crystal Run Healthcare plans to operate its MSSP ACO, explains Scott Hines, MD, co–chief clinical transformation officer at Crystal Run.
By not having a particular hospital as part of its ACO, the physicians at Crystal Run are free to send their patients to whichever hospital that provides the best quality at the lowest cost for a particular ailment or procedure. "It frees us up, at least in some way, to control the cost of the hospital," says Hines.
"Competition is good. We can tell hospitals that we are willing to increase our business there if they are able to prove to us that they are high-quality facilities that also have lower rates than their competitors."