Question #1: What is an ACO?

ACO is the acronym for “Accountable Care Organization.” An ACO is an organization of providers and suppliers that can include primary care providers, specialists, hospitals and ancillary care providers. In an ACO, participants are responsible for reducing the overall cost and improving the quality of care for their patients.

The Centers for Medicare and Medicaid Services (CMS), as required by the Patient Protection and Affordable Care Act, launched the “Medicare Shared Savings Program” (MSSP), which is a program that focuses solely on Medicare fee-for-service beneficiaries. Many commercial payers are also interested in creating, and working with, ACOs to encourage reduced costs and improved quality for their insureds and beneficiaries.

Question #2:
Why would legacy Meridian be my best choice with which to partner in an ACO?

The goals of an ACO are to improve patient care, improve population health and to reduce costs across the continuum of care. To achieve these goals, the ACO will need to coordinate care across many providers, facilitate the sharing of information, emphasize wellness, focus on evidence-based medical practices and better manage chronic diseases like diabetes, CHF and COPD. Legacy Meridian’s desire is to focus on quality clinical care through the creation of a regional enterprise that has both the resources and infrastructure to successfully achieve shared savings. We are committed to assisting our physicians as both a partner and a resource as they work to provide value-based care in the new era of quality reporting and payment.

Question #3:
I care for patients in some non-Hackensack Meridian Health hospitals. Can I still be part of legacy Meridian’s ACO?

Yes, as long as 50% of the physicians in your practice are credentialed at a Hackensack Meridian hospital. If you are a primary care physician (PCP), you may still admit/refer patients to the same facilities you always have, regardless of whether or not you choose to participate in the ACO. However, physician group practices that bill for primary care services may only participate in a single Medicare Shared Savings Program ACO because CMS will assign Medicare beneficiaries to ACOs based on the patients’ receipt of primary care services from the ACO’s participants.

Question #4:
I am part of a group practice. Can some providers in my practice join the ACO and others not?

No. CMS will track participation at the tax identification number (TIN) level. This means that any provider billing with the group practice TIN will be included in the ACO.

Question #5:
Will my Medicare payments change under the program? What will it cost to join?

Under the program, you will continue to bill and receive your full Medicare payments the same way you currently do. Even if the ACO fails to save CMS money when compared to the risk-adjusted benchmark, there will be no financial penalty to the ACO, the ACO participants or the providers during the initial three-year participation period. The MSSP presents an additional payment opportunity. CMS will determine the ACO’s financial performance based on a calculated “benchmark” using the three prior years’ per capita Part A and Part B expenditures for all assigned beneficiaries. To the extent savings beyond the anticipated minimum savings rate has been achieved (and quality performance benchmarks are attained), Medicare will pay the ACO up to 50% of the savings. It will cost physicians nothing to join, and Meridian will advance the start-up costs for infrastructure and necessary care management resources.

Question #6:
How will CMS determine which Medicare beneficiaries should be assigned to the ACO?

The ACO will report the TINs of all physician practice groups who sign up to be ACO participants. CMS will compile 12 months of historical claims data for all primary care services billed for by the ACO participants’ TINs for Medicare fee-for-service beneficiaries in the ACO’s service area. Beneficiaries will be attributed to the ACO if the plurality of allowable charges for primary care services provided by the ACO are greater than the allowed charges for primary care services furnished by providers not participating in the ACO.

Question #7:
Can beneficiaries decline to participate in the ACO?

Once attributed to an ACO, the beneficiary can still see any provider as part of their Medicare benefit. However, beneficiaries may decline to share their medical claims data with the ACO. If the patient chooses to decline data sharing, the ACO will still be responsible for cost and quality metrics of the beneficiary but will not receive any identified claims information on the beneficiary.

Question #8:
What Quality Measures will be reported to CMS? How will this be accomplished?

CMS has issued 30 quality measures for the MSSP, in addition to rewarding the ACO for its number of primary care physicians enrolled in the “meaningful use” program for electronic health records. The measures will be collected in one of three ways: (1) CAHPS Survey (no action required by provider to report), (2) claims data, or (3) self-reporting via GPRO. Many practices are already collecting much of the data as either part of PCMH demonstration projects, or as participants in the PQRS initiative. The measures fall into four areas: 1. Patient/Caregiver experience (8) 2. Care Coordination/Patient Safety (10) 3. Preventive Health (8) 4. At risk populations (5) Many measures will be captured through billing information or by direct survey from CMS. Meridian is committed to assisting ACO participants as much as possible in the collection of quality data.

Question #9:
How much shared savings can I expect to receive and when will I receive a check?

A number of factors influence the shared savings distribution. First, the ACO must have exceptional achievement on the quality metrics. Poor performance on quality measures will reduce or prevent the payment that the ACO could receive. Next, the ACO must achieve the minimal savings rate identified by CMS. This rate is determined by the ACO’s number of assigned beneficiaries, total ACO expenditures, and historical benchmark data. As CMS uses a three-month claims run out to calculate the ACO’s expenditures for each performance year, the ACO will not know the amount of its shared savings payment until the second quarter following the close of a performance year.

Question #10:
Must the Meridian ACO have agreements in place with providers at the time of application to CMS? How long is the term?

Yes. As part of its application, the ACO must certify that the ACO, its ACO participants, and its ACO providers/suppliers have agreed to become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to the ACO. Although each provider is required to commit to a three year agreement with CMS, they recognize there may be reasons why a provider may leave or be added during the course of the agreement period. When such changes occur, the ACO must notify CMS within thirty days of the change.

Question #11:
Can I join an ACO after the application period?

Yes, however providers that join an ACO after the application is submitted to CMS may not be attributed beneficiaries until the next performance year, which may adversely affect the ACO’s attainment of savings.

Question #12:
Can I leave the ACO after the start of the performance year?

Yes, however physicians that elect to leave an ACO will not be removed from the CMS’ participant list until the following performance year.

Question #13:
How will joining an ACO impact my day-to-day office operations?

While the day-to-day impact of participating in the MSSP will be minimal, success in the program will require high achievement on quality metrics. Precise medical claims coding and record documentation will optimize your ability to successfully report quality metrics. Your office will receive information from Meridian ACO to help you in this effort. Your office will not be required to report any information to CMS directly; the Meridian ACO will collect all necessary information from your office and will report to CMS on your behalf.

Question #14:
What are my next steps? When do I need to sign up by?

To join for the 2018 performance year, print and complete the agreement, and mail the completed agreement to:

Meridian ACO
Attn: Dr. Clarke
1350 Campus Parkway, Suite 201
Neptune, NJ 07753

If you have additional questions, please call the Meridian ACO at 732-481-8551. We look forward to your help and participation as we all work together to embrace the challenges ahead.