🔒Hospitals look beyond ACA ruling

Maine Hospital Association President Steven Michaud says that although the ACA presents challenges to hospitals and other health care providers, it also offers opportunities and momentum for initiatives already under way to reform care.

Among those initiatives are Accountable Care Organizations, which are enabled by new rules within the ACA to help doctors, hospitals and other providers better coordinate care for Medicare patients. ACOs create incentives for health care providers to work together to treat individual patients across care settings — including doctor's offices, hospitals and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first. Patient and provider participation in an ACO is purely voluntary.

Instead of patients receiving each part of their health care separately — visiting a primary care doctor on Monday and a specialist on Tuesday — and assembling a patchwork of health services, the ACO would bring those providers together to ensure all are working well together with respect to the patient's health care needs.

Earlier this year, The Aroostook Medical Center in Presque Isle and Brewer-based Eastern Maine Healthcare System launched the Pioneer Accountable Care program — at that time one of only 32 organizations across the United States invited to become an ACO through the federal Centers for Medicare and Medicaid Services. The five-year pilot project has more than 3,000 Aroostook County residents. An additional 5,000 people served by EMHS will be enrolled.

The switch

Jason Parent, spokesman for TAMC, says the initiative shifts the payment model away from the current fee-for-service approach — in which more visits, tests and procedures equals more money coming in, and which tends to be passive, waiting for patients to seek treatment. The new model, by comparison, will reward health care providers for keeping their Medicare patients well rather than for only treating illnesses. It encourages them to be proactive in helping patients to stay as healthy as possible and thereby avoid expensive procedures or hospitalization. That shift in focus is expected to reduce the cost of care.

Although Accountable Care Organizations were included in the ACA as a way to reduce Medicare costs — with the federal Department of Health and Human Services pegging the savings at up to $960 million nationwide in the first three years — Parent says The Aroostook Medical Center didn't intend to drop the new model if the Supreme Court overturned the law.

"We're skating to where we see the 'hockey puck' is going," he says, explaining that while the Pioneer program focuses on Medicare patients, its emphasis on prevention benefits everyone.

Other health care organizations in Maine are quickly signing up as Accountable Care Organizations. In early July, three additional Maine ACOs were chosen to participate in the Medicare Shared Savings Program created by the ACA:

• Lewiston's Central Maine ACO, which includes partnerships among group practices, hospitals and approximately 566 physicians
• Augusta's Maine Community ACO, a federally qualified health center with 125 physicians
• Portland's MaineHealth ACO, a network of practices, hospitals and 1,595 physicians.

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