tag:blogger.com,1999:blog-6389859942362181544.post7979467669494630355..comments2023-12-07T12:16:19.091-05:00Comments on Future of Family Medicine: Leading New Models of Practice - Accountable Care OrganizationsSebastianhttp://www.blogger.com/profile/12478213202416223770noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-6389859942362181544.post-41286421154280961482011-05-13T17:57:23.711-04:002011-05-13T17:57:23.711-04:00The commentary is inaccurate in that the law stipu...The commentary is inaccurate in that the law stipulates that an ACO have a minimum of 5,000 medicare beneficiaries and primary care sufficient to care for the population, regardless of its size. Also, alignment of patients with the ACO ("attribution" in the PGP demonstration, the "field test" for this model of delivery)is done using an approach based on the plurality of care given based on charges (to give some weighting to the method) a narrow group of largely primary care E/M services by an FP, GP, IM, or geriatrician. So, I'd say that primary care plays a noteworthy, if not central role here.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6389859942362181544.post-69147599094391032282011-05-08T11:11:38.832-04:002011-05-08T11:11:38.832-04:00Despite the 400+page proposal from CMS on the spec...Despite the 400+page proposal from CMS on the specifics of ACOs, I'm still skeptical. I do appreciate the goal of sharing cost-savings, but I'm not certain their is enough incentive to drive large systems to participate. <br /><br />At this point, these systems can take advantage of reimbursement for patient admissions every 31 days. So, from the business-side of things, a patient that has 10 stays a year generates significant revenue.<br /><br />Contrast that with the revenue savings that can be "shared". It would be impossible to generate the same kind of revenue seen from frequent admissions. It's the right and ethical thing to do for the patient, but it doesn't make the most business sense. And I think large systems have much to risk in entering this model.<br /><br />From the perspective of family medicine, I think the ACO is definitely the top-down approach. That means the family doc isn't directly a part of the equation. However, I like to think of everything as a continuum. I like to think of the family doc at the center of the equation, supported by a PCMH. From their, PCMHs can be units within a grand ACO. Why can't these models be integrated?Aaron Georgehttps://www.blogger.com/profile/18312286912911844560noreply@blogger.com