ACO Participation Prepares FPs for MACRA Implementation

When HHS' much anticipated proposed rule on the Medicare Access and CHIP Reauthorization Act (MACRA) was released late in June, many physicians across the country heaved a sigh of relief.

Although the proposed rule needs improvement, at last there was a blueprint, of sorts, to guide the massive shift in Medicare physician payment.

There was a very different reaction from others who remain unconvinced that this future payment environment -- with its advanced payment models (APMs) and Merit-based Incentive Payment System (MIPS) tracks -- will work for them and their patients.

But what many physicians may not recognize is that they've been doing the preparatory work leading up to these changes for years.

That certainly is the case for physicians engaged in accountable care organizations (ACOs) -- defined as a group of doctors, hospitals and other health care professionals who come together voluntarily to give their patients coordinated, high-quality care.

Perfect Timing in Tulsa

Terry Mills, M.D., is senior medical director at St. John Clinic -- part of Ascension Health's larger Tulsa, Okla.-based St. John Health System. The clinic is in its third and final year of a Medicare Shared Savings Program (MSSP) ACO.(

Mills oversees all of the clinic's primary care operations, including 130 primary care physicians and midlevel providers who care for 157,000 patients spread throughout 24 clinic sites; the ACO covers 11,000 of these patients.

He also chairs the AAFP's Commission on Quality and Practice. "I know our members are pretty anxious about MACRA; there's a lot swirling around," Mills told AAFP News.

But physicians at St. John have a leg up on what's ahead.

"At St. John, we did not necessarily expect to make money with the ACO. We expected to gain valuable critical experience," said Mills. "The ACO was seen as a way to start building the infrastructure, figure out the data collection and reporting, start aligning our physicians and, most importantly, engaging our community in order to be successful in the future," he said.

But can physicians who've not had the benefit of an ACO "boot camp" experience still succeed in these future models?

"You don't have to be in an ACO or a recognized medical home to do this," Mills insisted. "Family medicine is heart and soul about serving our patients and communities; we bring value with almost everything we do. The rub comes down to data collection and proving that value.

"If you've got four docs in a private practice, I guarantee those four doctors can sit down at lunch on Tuesday with their staff, decide on their four big clinical goals this year, and then figure out how to measure that. Those are the basics."

He was emphatic that family physicians can no longer ignore the value-based paradigm, stay on the fee-for-service hamster wheel and expect to do well. "That's not going to be a comfortable position in a couple of years," he said.

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