Information for Physicians
An Accountable Care Organization (ACO) refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that work together to coordinate care for the Medicare Fee-For-Service patients they serve. The goal of an ACO is to deliver seamless, high-quality care for Medicare beneficiaries, instead of the fragmented care that often results from a Fee-For-Service payment system in which different providers receive different, disconnected payments.
Primary Comprehensive Care ACO, LLC is a patient-centered organization in which the patient and providers are true partners in care decisions. ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and with post-acute care services. The Medicare Shared Savings Program (Shared Savings Program) rewards ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first. Provider participation in an ACO is purely voluntary.
How Do ACOs Help Physicians Coordinate Care?
Health care providers have reported that a barrier to improving care coordination is lack of information.
While they may know about the services they provide to the beneficiary, they don’t know about all other services provided to the beneficiary. To better treat patients and to coordinate their care, ACOs will receive Medicare claims information about their patients 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 claims information from CMS. ACOs must allow beneficiaries to decline having their claims information shared with the ACO (the “opt out” process).
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 patients or CMS’ use of the patient’s data for the purpose of assessing ACO’s performance on quality or cost measures (the ACO will not receive the data).
How Does Shared Savings Work?
Medicare will continue to pay individual providers and suppliers for services as it currently does under the Medicare Fee-For-Service payment systems. Primary Comprehensive Care ACO, LLC. is participating in the one-sided risk model, in which the ACO shares in both savings only. If the ACO saves money, the ACO and its physicians will be able to share in the savings.
How Can Physicians Participate In Primary Comprehensive Care ACO, LLC.?
Physicians who are interested in participating in Primary Comprehensive Care ACO, LLC., should contact the ACO at firstname.lastname@example.org or at 773-237-0755.