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#1 Pillar To ACO Savings

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Dear All Physicians,

Congratulation, you’re a part of the physicians directed solution of CMS to save Medicare!

The following will occur in coming weeks:

  1. Your patients will receive a letter from CMS indicating that their physician is a part of the Accountable Care Organization (ACO).

Patients may call your office, inquiring about the letter.  Please inform your patient that:

ü  Doctors ACO is a group of doctors, who work together to provide you with better, more coordinated care. Physicians in an ACO communicate with you & with each other to ensure that you get the care you need when you’re sick, and the support you need to stay healthy and well

ü  An ACO isn’t an HMO, managed care or insurance company. Unlike HMOs, managed care, or some insurance plans, an ACO can’t tell you which health care providers to see and can’t change your Medicare benefits

ü  Your right to choose any hospital or doctor that accepts Medicare, at any time, will not change even if that doctor or hospital not part of an ACO

ü  The providers participating in the ACO will become partners with you in making care decisions.  You don't have to have the same medical tests done over and over because your results are shared among your health care team

ü  The privacy and security of your medical information is protected by Federal law.  The group of doctors, hospitals, and other health care providers working together in the ACO will be able to read your medical records, along with other office staff authorized to help coordinate your care

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Now days, our doctors are facing steadily rising medical malpractice premiums, which have led them to seek alternative source apart from the traditional policies and services provided by large independentcommercial insurance companies. 

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What is Captive Insurance? Captive insurance companies are insurance companies established with the specific objective of insuring risks emanating from their parent group or groups, but they sometimes also insure risks of the group's customers.  This is an alternative form of risk management that is becoming a more practical and popular means through which companies can protect themselves financially while having more control over how they are insured.

Doctors ACO is seeking innovative solutions to save $ for our ACO Physicians.  Captive Insurance is one of the ways that our physicians can save tremendous amount of money in their medical malpractice premiums.  Doctors ACO believes “Captive Insurance” is an economical way for doctors to have malpractice insurance.  For instance, as the captive's owner, the insured physician can be directly involved in major decisions made by captive regarding underwriting, investment policies, claim management, and quality improvement.

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1. Status of Doctors ACO

We’re pleased to announce that the Medicare Shared Saving Program (MSSP) application for Doctors ACO has been submitted and we received receipt verification from the Centers for Medicare Services (CMS).

As of today in Doctors ACO:

  • 140   Physicians - Combined  Georgia/Ohio total
  • 55 Medical Practices
  • 26   Mid-Level Providers

2. If you have missed the deadline

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BOYNTON BEACH — 

Horror stories of medical costs gone wild abound in South Florida, such as a $40,000 list of charges for a two-day hospital stay to check out a Boynton Beach man’s muscle bruise. His wife called that “ridiculous.”

But 29 groups of doctors across the country have received bonuses for lowering costs to taxpayers while keeping patients happy — and two based in Palm Beach County accounted for one in eight dollars nationally in savings shared with Medicare.

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Doctors ACO wants to clear the confusion about the Annual Medicare Visits. The Annual Wellness Visits (AWV) takes place with one’s primary care provider, and has NO deductibles, NO Coinsurance, and NO Copayments. An AWV includes:

  •          Establish patient's medical and family history.
  •          List of patient's current medical providers.
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The Accountable Care Organization (ACO) model was introduced by the government in 2011 to save Medicare future.  We are excited to form an independent physicians owned Accountable Care Organization in our community to reduce waste and control healthcare costs.  What is an ACO? ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.  The purpose of this program is to take responsibility for providing quality healthcare and controlling healthcare waste in our communities. 

Accountable Care Organization is an experiment from CMS to save Medicare’s future.  This experiment has been successful as quoted by Patrick Conway, the chief medical officer for Medicare, who said, "On 15 out of 15 quality measures, [ACOs] did better than national benchmarks, as well as on four out of four patient satisfaction benchmarks." Twenty-nine of those ACOs saved enough to generate bonus payments totalling $126 million.  In addition, the ACOs generated $128 million in net savings for Medicare's trust fund. This concept may turn out to be the idea which can save the future of Medicare and ensure high quality health care for our seniors. (https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-01-30.html). 

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Government, Insurance Companies, Physicians or Patients? I am excited to be joining Dr. Doy Gay, in inving all independent Georgia physicians to join Doctors Accountable Care Organizaon (Doctors ACO). The Centers for Medicare & Medicaid Services (CMS) established the ACO system in an eiort to give physicians the opportunity to manage healthcare spending for their Medicare paents.

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ANNUAL WELLNESS VISITS

Beginning in January of 2011, Medicare began covering totally free Annual Wellness Visits. The goal of this hour long visit is to develop a plan to fight preventable diseases such as heart disease, cancer and depression. Doctors ACO (an Accountable Care Organization) has found that only 7% of Medicare patients are taking advantage of this exam. The reason for this low utilization is that many physicians are not equipped to administer this detailed visit within Medicare regulations. (http://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html) Doctors ACO believes this testing is an important element in promoting the healthiest lifestyle for seniors and has trained physicians who can provide this free visit within Medicare regulations. Doctors ACO invites you to call today to make this important preventive appointment for you or your loved ones. (706) 208-9700

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b2ap3_thumbnail_Jarrod-Rowe-1.jpgContinuing the conversation started by Qamar Islam in his article printed on October 29th, we would like to propose a few more ways to contain healthcare costs in addition to taking ownership of your medical records. There are several ways you can save money when it comes to managing your sleep health.

Tip #1: Evaluate the medical facility. When a facility can diagnose,

treat, provide medical supplies and follow up appointments, the costs are significantly lower and care improves. For example, Athens Sleep and Wellness Center has taken this idea of a one-stop-shop and put it into practice by providing initial consultation, diagnostics, DME services and CPAP clinic follow-ups.

This integrated approach allows for shorter turnaround times, quicker treatment initiation, better care and lower healthcare costs. With customized follow up, compliance with therapy rises and healthcare outcomes improve.

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US Healthcare Costs Continue to Rise:
 Our country’s healthcare spending was 2.6 trillion in 2010 and is expected to rise up to 4.8 trillion by 2021. An estimated 49 million Americans lacked health insurance in 2011. Americans who had health insurance had to pay 7.2% more between 2011 and 2012. Who is responsible for controlling the healthcare costs? Is it insurance companies, hospitals, physicians, government or you?

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Medicine is a noble profession and one chooses this profession as he/ she is drawn to a life of service to others. Declining reimbursement by both public and private insurance companies is forcing physicians to become more of a business person and less of a physician. The sacred places where patients were once truly cared for are now turning into “profit centers.” Patients are being seen as consumers only and their best interest is not always safeguarded. Our patients need guidance; they need help and we strongly believe that physicians are the best advocates for them. According to a recent report by the Institute of Medicine (IOM), as much as $750 Billion out of 2.3 trillion dollars were spent on unnecessary healthcare. “Physicians Circle for Patients (PCP)” can help reduce this waste. As we educate people to make smart choices, we will save some of the $105 billion currently being wasted on unnecessary services. By physicians sharing patient medical records with other physicians and building a system to make sharing easy, we will be able to save some of the $210 billion wasted on unnecessary/duplicate services. Virginia Mason Medical Center currently has a ‘Lean Technique’ management methodology for eliminating waste, improving quality and safety and reducing cost. By learning and sharing information about this system with other medical facilities, we can effectively reduce the $130 billion being wasted on inefficiently delivered services.

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The Doughnut Hole is No Sweet Deal
 
The ‘Doughnut Hole’ is a term that describes when a Medicare patient falls into the ‘Coverage Gap’ of their prescription insurance plan. During this period, a patient will have little to no prescription insurance coverage
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Government, Insurance Companies, Physicians or Patients?

I would like to invite all of Georgia’s primary care physicians to join me in the Doctors Accountable Care Organization (Doctors ACO). Through Doctors ACO, we will utilize an opportunity offered by Medicare to spend each healthcare dollar wisely. This physician led organization will create an integrated healthcare delivery system. I believe a physician is responsible for ordering treatments for their patients that is best suited to cut waste and develop efficiency in the health care delivery. As primary care physicians, we will partner with the most efficient specialists and hospitals to get the best healthcare outcome for our patients. In order to save Medicare dollars for our seniors, primary care physicians not only need to manage patient’s health; they also need to manage healthcare dollars allotted by Medicare to that patient during a year or for their life time.

A recent report showed that 54 out of the 114 Medicare Shared Saving Program participants similar to our planed Doctors ACO had lower than projected expenditures in their first 12 months while improving patient satisfaction and quality of medical care. Patrick Conway, the chief medical officer for Medicare, said, "On 15 out of 15 quality measures, [ACOs] did better than national benchmarks, as well as on four out of four patient satisfaction benchmarks." Twenty-nine of those ACOs saved enough to generate bonus payments, which totaled $126 million. In addition, the ACOs generated $128 million in net savings for Medicare's trust fund. This concept may turn out to be the idea which can save future of Medicare and ensure high quality of health care for our seniors.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-

Press-releases-items/2014-01-30.html

Doy O. Gay, MD is a primary care physician in Winder, Georgia. He has been practicing Family Medicine for the last 25 years. He can be reached at 770-867-9186.

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