SPRINGFIELD, Mo.– It happens to a lot of us: you go to your regular doctor, have blood drawn and then repeat those tests when referred to a specialist. Now, Mercy patients in the Springfield area can look forward to fewer needle sticks and other repeat tests. All of their doctors have committed to coordinate care for their chronic illnesses, schedule timely health screenings and follow up on minor illnesses.
The Centers for Medicare & Medicaid Services (CMS) has named Mercy Hospital Springfield and Mercy Clinic Springfield Communities as an Accountable Care Organization (ACO). ACOs are organizations formed by groups of doctors and other health care providers that pledge to coordinate care for patients covered by Medicare. In exchange, those providers have the opportunity to share in savings realized by working together to keep patients healthier while eliminating unnecessary expenses.
“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” said Health and Human Services Secretary Kathleen Sebelius. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.”
Participation in an ACO is purely voluntary. Since the passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established, including the 106 new ACOs named today. There are four now in Missouri, one which serves the Kansas City area, another in St. Louis, and one in St. Joseph, Mo. In all, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide. However, not every organization that applies to be an ACO is accepted into the program.
“You have to be recognized as providing high-quality medical care and have proven your doctors can work together in caring for a specific group of patients,” explained Dr. James T. Rogers, clinical vice president of Mercy Adult Primary Care. “This is part of our effort to do the right thing for patients and taxpayers by providing the best care possible without spending unnecessary money. Plus, patients will know how well we’re caring for them, as CMS tracks our performance and makes those results public.”
ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe and timely. CMS has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative are up to $940 million over four years.
Mercy Springfield doctors have proven they can meet CMS quality standards. They were one of only 10 physician groups in the nation to participate in the Medicare Physician Group Practice (PGP) project. Its intent was similar: to improve care while cutting costs. In year four alone, the project saved Medicare $38.7 million. Five of the 10 groups, including Mercy Springfield, received performance payments that year under the project because they saved money while scoring high marks for quality.
Mercy has 31 hospitals and 300 outpatient facilities across Arkansas, Kansas, Missouri and Oklahoma. It plans to use the findings from Mercy Springfield’s participation as an ACO throughout its service area.
“As we learn what works best for patients, we’ll share those best practices across the four states Mercy serves,” said Dr. Rogers. “We will relentlessly pursue our goal to get health care right, and this is a major step in that direction.”