Joining an ACO for 2015 (you'd better hurry...)
I'm cutting-and-pasting instructions from Dr. Frankel that he gave in another thread...
1. An ACO is the new managed care structure. The purpose is to reduce costs by 2% per year by increasing efficiency of care through the PCP .its been said a bunch of money providing a bunch care to a bunch of people for the year. Money left over is a bonus. No money left over leads to a trip to the wood shed.
2. Originally designed to be owned by hospitals, the regulations have been changed to allow other ownership such as insurance companies.
3. Panels of providers will provide the care. You've got to be on it to have equal access to the enrollees. You must prove to the ACOs that you are a wonderful dr. They want to know your background and your history in practice. If you've robbed a bank, forget it, they want to know if you're a criminal. In s nutshell, that vetting process is called credentialing. The CAQH has helped automate the process
4. As an inducement to join, the number of providers is limited to insure adequate patient flow as well as limiting the overhead costs for the ACO. Panels need to be populated by providers where the enrollees are, not where they ain't . So concentrate your efforts within a 25 mile radius.
5. I wanted your state associations to do this next step for you, but your emails tell me they didn't . ACOs must licensed by the state, I wanted them to compile a list including contact numbers. They didn't so you have to either contact the state for the names and numbers or try google. This is not a time for emails, but personal phone calls. Ask for their plans for an ACO and if they can send you an application either by mail, or on line ,as well as a packet of I formation including fee schedules .
6. Contact provider relations for every insurance company you deal with. Repeat step 5 with one addition. Ask if your credentials can be transfered to the ACO. This will expedite your being iincluded in the panel.
7. Call the Med Staff office of every hospital within your practice demographics. Ask if the hospital is starting an ACO and if they are,the phone number of the contact person. If they are not ,ask if they are aligning with any ACOs. Again, ask for contact names and numbers. Repeat step 5. Follow up all conversations with letters.
8. More of your income is going to be derived from professional rather than material fees. We need to achieve parity of panel access and parity of professional fees. As our scope of practice has increased, so has our ability to treat a greater range of patients in a more cost effective manner. This makes us more attractive to the ACOs. Less OMDs will be necessary for the panels and more ODs required.
9. Make sure that the state associations have firmed up our legal protection as well as scope of practice . I detailed this previously. It will help if you run into any problems.
10. Start tomorrow !
I tried to simplify this as much as possible. Hope this helps.
