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

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

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."

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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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