Frequently Asked Questions
Participating in an ACO is purely voluntary for providers. We realize different organizations are at different stages in their ability to move toward an ACO model. We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to participate in and begin this work, no matter your organization’s stage.
Coordinated Care means that all the healthcare professionals work together to assure that the patient gets the right care at the right time. Healthcare professionals will communicate with each other, with the goal of preventing medical errors and avoiding needless repetition of services.
- Increase communication among primary care and specialty providers who work together and share vital information to plan the best possible patient care;
- Health care providers who can anticipate patient needs and begin treatment before serious complications occur;
- A decrease in the potential for duplicated and/or unnecessary testing or services;
- The development of new programs and services aimed at keeping healthy people healthy and helping those with chronic illnesses manage their own care;
- Increased communication between health care providers and patients; and
- An overall improvement in health care services and better outcomes.
Health care providers have reported that a barrier to improving care coordination is the lack of information. While they may know about the services they provide to the beneficiary, they are unaware of all other services provided to the beneficiary. To better treat Medicare fee-for-service beneficiaries and to coordinate their care, ACOs will receive Medicare health information about their Medicare fee-for-service beneficiaries from CMS, regardless of their location of care. Before doing so, ACOs must notify a beneficiary in writing that it will request the beneficiary’s health information from CMS. ACOs must allow beneficiaries to decline having their health information shared with the ACO.
Declining to have this information shared, however, does not affect the provider’s participation in the ACO, the care that is delivered by the provider to their Medicare Fee-For-Service Beneficiaries or CMS’ use of the beneficiaries data for the purpose of assessing ACO’s performance on quality or cost measures (the ACO will not receive the data.)
Medicare will continue to pay individual providers and suppliers for services as it currently does under the Medicare Fee-For-Service payment systems. Doctors ACO is participating in the risk-free CMS Shared Savings Program. If the ACO lowers its health care costs while meeting performance standards on quality of care and putting patients first, Doctors ACO and its physicians will assume no downside risk.
Doctors ACO management team will be investing substantial sums in the range of $1 million to $1.5 million in the operating expenses for the first 22 months (first 12 months plus another 10 months until the first shared savings check is received).
- Commitment of Development Funds - $1,000
- No other obligation or risk.
- Local physicians participation in governance.
- Can withdraw at any time - With no penalty associated.
Doctors ACO Management Company will take 30% profit sharing and 70% will be shared within Doctors ACO physicians. After the expenses the profit will be shared between the PCP (80%) and Specialist (20%).
- 40% based on Assigned Beneficiaries
- 40% based on performance (Shared Savings)
- 20% equally
Doctors ACO Management Company has 30% ownership and 51% voting Governance/Operations.
Doctors ACO Physicians Members have 70% ownership and 49% voting Governance/Operations.
Doctors ACO physicians will only be investing $1,000 each. Not a penny more. In fact, Doctors ACO management team will limit the amount of operating expenses charged against shared savings. They will charge $6 per month per member for up to 5,000 beneficiaries and $4 per member over 5,000. Although, operating expenses will likely exceed $6/$4 per member, the excess will not be charged to Doctors ACO. Management team will absorb operating costs over $6/$4 per member.
The local ACO physicians will make decisions regarding the management of the ACO physicians. The local ACO physicians can decide on the physicians that will sit on the Board, various Committees and the selecting of a Medical Director. Also, the local physicians can decide on what grounds the physicians can be terminated from the ACO.
Doctors ACO management team has several good IT vendors who will provide monthly, quarterly, semi-annual, and annual reports regarding the overall ACO performance as well as the performance of important cost categories such as hospital admissions, re-admissions, home health care, high cost patients, etc. In addition, physician report cards will be used regarding the individual physician’s performance and how they compare to the other participating physicians. We have an experienced ACO-CIO to support all the needed financials, clinical analytics, and quality reporting. We fully understand the need for transparency and data sharing and will want the physicians to have as much information on a current basis, as is realistically possible.
The data will be available to all physicians and we want to have physician specific reports based on information from the participants and from CMS.
No, physicians who participate in Doctors ACO have their own choice of what DME supplier or imaging company that they would like to use, as long as the supplier or company is Medicare approved. Physicians still have a free choice as they did prior to joining.
No, the phsycian may choose to use what ever type of media (paper, electronic) for their medical records.
No, you will continue to bill the Medicare fee-for-service with no changes.
There is no financial risk or liability associated with joining Doctors ACO. The only monetary contribution made by participants is the $1,000 participation fee which will be returned upon recieving the Cost Report Data and savings payout from CMS.
The one-sided, no-risk model is where providers only share in savings and are not effected by the losses. Opposing the one-sided model, is the two-sided model. This is where providers share in both savings and losses. Doctors ACO is a participant in the one-sided model, where there is no-risk associated with our participation with CMS.
Yes, you may join Doctors ACO as long as you are a physician located in the state of Georgia and seeing at least one Medicare beneficiary.
No one will need to change EMR systems to participate with the Doctor’s ACO. All modern EMR's have the capability to provide the info the ACO needs to do its job.