Over the past several years, physician groups and hospitals in various markets have started participating in accountable care organizations (ACO). Some ambulatory surgery centers (ASCs) have already joined ACOs, while others try to determine if they should get involved or go in another direction.
Before you can determine if being a part of an ACO is right for you, it’s important to fully understand ACOs, some of the potential hurdles for contracting with them, and some insider tips on surviving in an ACO market, whether you decide to join one or not.
What’s an Accountable Care Organization?
What is an accountable care organization? An ACO is an organization that contracts with providers and enrolls patients to provide coordinated, high-quality services through Medicare or commercially. If providers in the ACO can improve specific quality metrics or lower costs within a timeframe, they’re able to enjoy financial resorts from or at least share in the cost savings with a commercial payer or Medicare.
ACOs often bring together a variety of entities to help leverage those benefits while reducing some of the restrictions that are imposed by common ownership or physical facilities. The idea of “shared savings” is designed to keep all ACO participants coordinating care and reducing costs, actually reversing the incentive system so it’s more beneficial to eliminate unnecessary procedures.
For ambulatory surgery centers, two scenarios may play out.
- 1 – An ASC gets involved with an integrated network that’s part of an ACO in a geographically similar location. The ASC can then negotiate with the ACO for some of the shared savings available. The drawback with this option is that ASCs may have limited leverage when negotiating those shared savings rates compare to some of the other providers who are part of the ACO.
- 2 – Another scenario is for a group of ASCs to create their own ACO that covers a large geographic territory and then bit on ACO contracts in that territory. This provides ASCs with far greater leverage within their markets and may result in higher reimbursements. However, there can be some complexity in building an ACO that has such a wide range.
Hurdles for ASCs Contracting with ACOs
In many local markets, it’s hospitals driving ACOs. If your ASC wants to contract with a local ACO, here are a few hurdles to considering, according to Becker’s ASC Review.
- Hurdle #1 – Keep the ACO legal structure in mind. Your surgery center must conform to a certain legal structure, but an ACO may be conforming to another. Think about how getting involved with an ACO may affect your compliance.
- Hurdle #2 – Ensure you have a voice. Since ACOs usually have a board that has the decision-making authority over the organization, you need to ensure that you’ll have a voice with that board or any other type of governing body.
- Hurdle #3 – Be ready to exchange information. When you’re involved with an ACO, you’ll need to be able to share health information. Think about how you can leverage current information systems in place to exchange health data securely across locations.
- Hurdle #4 – Realize that quality reporting is a must. You already have reporting requirements for your ASC, but there’s an extensively defined reporting process when you’re a member of an ACO, specifically when it comes to outcomes of care and costs of care. If you join an ACO, you’ll need to report this information.
Tips for Surviving in an ACO Market
Whether you decide to get involved in an ACO or not, it’s important to keep a few tips in mind as your ASC moves forward in the current ACO market.
- Work to meet ACO goals. ACOs work to lower the cost of care and improve quality, and even if you don’t get involved in an ACO, showing that your ASC’s cost of care and quality meet ACO standards is critical.
- Use data-tracking systems. It’s more important than ever to track data, whether you join an ACO or not. Start by implementing electronic systems, including electronic medical records, that keep track of cost data and outcomes.
- Understand your ASCs geography. Before you go decide to become part of an ACO, be aware of your geography. In some areas, it might make more sense for your surgery center to join an ACO. Check out the health systems and geography closest to you to determine the patients that might be part of commercial ACOs.
- Build strong relationships with providers and payors. If you already have good relationships with providers, physicians, and payors in your community, you’re better equipped to build on this foundation if you turn to an ACO or ACO-like payment model moving forward.
- Add procedures to your surgery center. The more types of procedures you’re able to provide at your ASC, the more cases ACOs can bring you. Consider expanding your services to offer more procedures that can be moved out of the more expensive acute care setting into your ambulatory setting, which offers big savings.
ACOs do have the potential to capture a significant amount of healthcare dollars, which means ASCs may be able to find excellent opportunities in joining the right ACO. If you plan to join an ACO and need help with your billing and coding needs, M-Scribe.com can help. Contact us today to find out more about how we can help you thrive while reducing denials, lowering costs, and improving revenue.