ST. LOUIS – Mercy’s long-standing commitment to providing quality care while lowering health care costs is paying off, according to data recently released by the Centers for Medicare & Medicaid Services (CMS).
CMS released its public use files this fall, which showcase how the nation’s 548 Accountable Care Organizations (ACOs) stacked up in 2018 in terms of quality and cost savings to taxpayers. Mercy Health ACO – the largest ACO in the country by number of Medicare patients served – saved taxpayers more than $29 million in 2018 while achieving a quality score of 92.43%.
“This shows we are doing the right thing for our patients,” said Dr. Marc Gunter, president of Mercy Clinic. “Everyone knows that health care costs too much, and we have made significant investments over the years to help our patients live their healthiest lives possible while also saving them money.”
ACOs are organizations formed by groups of doctors and other health care providers that pledge to coordinate care for patients covered by Medicare with a goal of keeping them healthier while eliminating unnecessary costs.
Each year, CMS sets a benchmark for each ACO based on quality and cost-reduction efforts. If an ACO meets that benchmark, the organization will receive a portion of the money it saves Medicare. The higher the ACO scores on its quality measures, the larger percentage of that savings it will receive.
Since Mercy’s ACO met its CMS benchmark in 2018, the organization received more than $13.1 million out of the total $29 million savings to taxpayers.
Mercy’s $13.1 million savings will be reinvested in continued efforts to improve care while reducing health care costs. This includes ensuring primary care services are available to patients in both urban and rural areas and investing in technology – like the electronic health record system and telemedicine – to keep patients out of the hospital and to minimize medical expenses by avoiding repeat or unnecessary tests.
To become an ACO and maintain that designation, organizations must score high on certain quality measures and prove that providers can work together in caring for a specific group of patients. CMS has established more than 30 quality measures that focus on care coordination, patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.
One of the CMS quality measures is to reduce hospital readmission rates. If a Medicare patient is readmitted to the hospital within 30 days of a previous hospital stay, CMS defines that as a readmission. Mercy’s readmission rate was better than nearly nine out of every 10 ACOs in 2018.
“Keeping readmission rates low means patients stay healthier, have a better quality of life and are not paying additional medical costs,” said Dr. Gunter.
This matters to patients like 84-year-old Edith Schuler.
Schuler, who lives in Oklahoma City, has pulmonary hypertension and congestive heart failure – a chronic condition that occurs when a person’s heart is not pumping as well as it should, which can cause fluid to build up in the body. When this happens, patients may gain weight, feel short of breath and have swelling, especially in their legs, feet and ankles.
She was enrolled in Mercy’s vEngagement program in July after two hospitalizations for breathing problems over a two-month period earlier this year – including a 10-day hospital stay when she had pneumonia and nearly died. The program, offered at no charge to Mercy patients, provides care to patients with chronic medical conditions in their home through a secure internet connection, a tablet computer and wireless monitoring equipment.
Through the program, the Mercy Virtual care team can let Schuler know if something looks wrong by monitoring a variety of vital signs. Readings alert Mercy Virtual team members to sudden changes so they can reach out to see what’s happening and make adjustments to her treatment plan, if necessary.
She also participates in a weekly video conference with the Mercy Virtual team and can alert them anytime if she doesn’t feel well. Her primary care provider, who works in conjunction with the physician-led virtual care team, is also alerted to any changes in her status through Mercy’s electronic health record.
“I’m learning a lot in this program about what you can and can’t do,” said Schuler. “They keep me on my toes.”
Since beginning the program three months ago, Schuler has not been hospitalized or seen in the emergency department. She is feeling better than she has in a long time and is now able to play with her grandson’s dogs, do her own laundry, move around more with the assistance of a walker or cane and go to the grocery store with her daughters. She hopes to begin using a recumbent bicycle in the coming weeks or months as she continues to feel better.
“I’m here and I feel wonderful,” said Schuler. “If you do what they tell you to do and take care of yourself, you’re going to feel better and better.”
Mercy Virtual’s program isn’t for everyone. It’s targeted to those with multiple chronic conditions who are frequently in and out of the emergency room and hospital.
Since fall 2015, the virtual program has improved the lives of nearly 4,200 patients. This has led to:
“This is one of many ways in which Mercy is making a difference in the lives of our patients by providing care when and where they need it without always having to make a trip to their doctor’s office or to the hospital,” said Dr. Gunter. “We’ve invested in these innovative programs for years and will continue to look for additional ways we can deliver the very best care to our patients.”
To learn more about Mercy’s Virtual Care programs, visit mercyvirtual.net. For more information on ACOs, visit the Centers for Medicare & Medicaid Services’ website at cms.gov.