Gainesville doctors form group to help Medicare's efficiency
Published: Friday, January 25, 2013 at 5:09 p.m.
Last Modified: Friday, January 25, 2013 at 5:09 p.m.
Gainesville is taking a big step toward implementing the Affordable Care Act with the creation of an accountable care organization that is intended to keep patients healthier while saving Medicare dollars.
The Physicians Care Network, an independent physician association, is partnering with Collaborative Health Systems to form one of the country's 250 accountable care organizations.
ACOs are a new model of care being implemented by the Center for Medicare and Medicaid Services that gives doctors and hospitals a spending target for patient care and allows them to keep some of the savings if they come in under budget. Eventually, they also will be penalized if they spend too much. The organizations must meet certain health care quality standards.
The idea is that providers will have an incentive to avoid needless spending — such as repeated diagnostic tests — and will focus on preventive care.
The Gainesville group is one of 106 new ACOs announced this month by Health and Human Services Secretary Kathleen Sebelius.
Dr. Robert Ashley, the medical director of Gainesville's ACO, said it will allow physicians to have more comprehensive information on their patients.
"Until now, I may not have had information about what's going on in the total health picture," Ashley said, adding that having more information at hand will allow for quicker, one-stop coordination of health care.
He described the model as putting "whatever it takes to put the muscle where the problem is to deliver more effective care."
"It doesn't change the setting of my practice, who my patients are, or where patients choose to go … It is hopefully going to coordinate services and make more services available through each primary care doctor," Ashley said.
In practice, this might mean that a patient with diabetes who also has vascular disease and an ulcer on his leg would have immediate access to a care manager, who could help organize home care and educate patients on their conditions, as well as provide them with access to a social worker and any other support services.
He thinks that as a result, ER visits and unnecessary readmissions will be reduced.
Chuck Trinchitella, the senior vice president of Collaborative Health Systems, the partnering organization in Gainesville's ACO, said the system puts the onus on the primary care doctors to coordinate patients' care with specialists, rather than have the patients do it themselves.
To form an ACO, providers must have at least 5,000 Medicare beneficiaries. ACOs have formed throughout the country, with a big concentration on the East Coast and in Texas, Trinchitella added. Florida has another one, in Pensacola.
Some of the ACOs formed last spring.
"So far we've been getting a lot of success stories — people who didn't realize they needed an annual exam, or patients on diabetic medication who didn't really understand seeing their primary care physician regularly," Trinchitella said. "That's where we talk about education and moving things forward."
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