Becker's Hospital Review

30 Clinical Integration & ACOs Majority of Patients Veer Outside of ACO Networks for Specialty Care By Ayla Ellison A study published in JAMA Internal Care found the majority of beneficiaries as- signed to an accountable care organiza- tion went outside of their assigned ACO for spe- cialty care. Using Medicare claims data from 2010 to 2011 and lists of physicians who participate in ACO programs, the researchers examined the propor- tion of patients whose assignment to an ACO in 2010 was unchanged in 2011, the proportion of office visits that occurred outside of the ACO and the proportion of Medicare outpatient spending billed by the ACO that was devoted to assigned patients. Major findings included: • Eighty percent of the beneficiaries assigned to an ACO in 2010 were assigned to the same ACO in 2011. • Beneficiaries with fewer conditions and of- fice visits were more likely to have ACO as- signment changes. • Nine percent of office visits with primary care physicians were provided outside of beneficiaries' assigned ACOs. • The number of beneficiaries seeking outpa- tient specialty care outside of their assigned ACO was greater for higher-cost beneficia- ries and occurred often even among special- ty-oriented ACOs. • Thirty-eight percent of Medicare spending on outpatient care billed by ACO physicians was for assigned beneficiaries. n Total Number of ACOs Tops 520 By Molly Gamble Fewer Hospitals, Health Systems Acquire Physician Groups By Heather Punke New research estimates 522 total accountable care organizations are serving 15 to 17 percent of the U.S. population. These figures are the latest from Oliver Wyman, which tracks ACO growth. The consulting firm's latest report from April contains several key statistics on the model's growth. The 522 total ACOs is an increase from 370 in September 2013 and 258 in February 2013. The majority of these are CMS ACOs — Pioneer ACOs, Medicare Shared Savings Program ACOs, Medicaid ACOs or participants in the Physician Group Practice Transition program. CMS' latest round of ACO approvals in January brings the total number of Medicare ACOs to 368, up from 235 in July 2013. Despite their target populations, the Medicare ACOs are still serving an estimated 33 million non-Medicare patients, according to the report. There are also about 155 non-Medicare ACOs in operation across the coun- try, a 14 percent increase from 135 in July 2013 and a 24 percent jump from 124 in January 2013. Non-Medicare ACOs serve between 9 million and 16 million patients. These ACOs are hard to track since there is no official data- base or tracking mechanism for commercial ACOs. Of the U.S. population, 67 percent live in a primary care service area served by an ACO, according to Oliver Wyman. That figure was at 45 percent in September 2013 and 52 percent in February 2013. Also, about 40 percent of the populations lives in a PCSA served by two or more ACOs. "We regard this last number as extremely important," Niyum Gandhi, Oliver Wyman partner and ACO expert, said in the report. "ACOs need to be treated as a triggering mechanism for a revolution in American healthcare. Their reach is at least as important a factor to watch as their current enrollments." Mr. Gandhi said now that two-thirds of Americans have access to an ACO and more than half have access to two or more, he has a prediction: "Once the fire is lit, it's going to spread quickly." n I n 2011, hospitals and health systems accounted for 51 percent of all phy- sician practice acquisition deals — but by 2013 they only accounted for 14 percent, according to a May analysis from PwC. Physician practice management companies are ramping up their physician practice deals. In the first quarter of 2014, management companies account- ed for all nine of the reported physician practice deals. PwC said the current trend of physician practice acquisitions by physi- cian practice management companies is expected to continue in the near term as specialty-based physician groups look for ways to respond to re- imbursement changes and higher regulatory costs of maintaining their practices. n

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