Tag Archives: ACO

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A ruling by the Internal Revenue Service creates a significant obstacle to a new type of health care network that the Obama administration has promoted as a way to provide better care at lower cost, industry lawyers and providers say.

Health care markets are rapidly changing as independent doctors and hospitals race to form networks, known as accountable care organizations, in which they coordinate care for patients. The doctors and hospitals have financial incentives to keep patients healthy and to control costs, and they can share in the savings if they meet performance goals.

The new entities, which now cover more than 28 million people, according to Leavitt Partners, a health care consulting firm, help manage care for Medicare beneficiaries, for people with employer-sponsored insurance and for consumers who buy coverage through online marketplaces under the Affordable Care Act.

In its recent ruling, the I.R.S. denied a tax exemption sought by an accountable care organization that coordinates care for people with commercial insurance. The tax agency said the organization did not meet the test for tax-exempt status because it was not operated exclusively for charitable purposes and it provided private benefits to some doctors in its network.

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Doctor Quality Data Unuseful to Consumers

Consumers searching this fall for the best doctor covered by their new public or private insurance plan won’t get very far on a federal database designed to rate physician quality.

The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It’s so limited, health care experts say, as to be useless to many consumers.

This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament.

A report out last week by the Georgetown University Health Policy Institute said insurers were limiting the choices of doctors and hospitals for those buying insurance on health insurance exchanges to keep premiums low.

The CMS data include only 66 group practices and 141 accountable care organizations (ACOs). There are about 600,000 doctors in the USA, tens of thousands of group practices and more than 600 ACOs, which are partnerships between doctors and hospitals to treat a group of patients efficiently.

The database lists just five areas of doctors’ effectiveness in treating diabetes and heart disease. These include whether doctors prescribed aspirin and how well they controlled diabetics’ blood pressure.

“They are behind, there’s no doubt,” says Terry Ketchersid, a kidney physician and vice president of clinical health information management for the electronic health records company Acumen.

“The goal of these sites is for the average Medicare beneficiary to go out and make an intelligent choice,” he says, but only another doctor would understand what to make of the ratings.

The CMS plans to add more quality measures and patient experience data for ACOs this year, spokesman Aaron Albright says. He says the CMS uses a “phased approach for public reporting to make sure the data are accurate and the measures reported help consumers make informed health care decisions.”

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Jeffrey R. Ungvary