The overall marketplace has seen a huge rise in accountable care organizations (ACO), largely arising from the ACA. The costs and resources of grouping together physicians across specialties into a delivery system can be immense. Ultimately, they can be structured in three different ways:
- Shared Savings Program
- Advance Payment ACO Model
- Pioneer ACO Model
Each of these requires knowledge of:
- What kinds of providers and groups will be involved, as well as whether it will be a mixture of pure Medicare HMO or Medicare and commercial
- What the potential private contracts are
- Permanent participants and potential credentialing requirements and if it is a shared savings model
- (Flat fee) payment scheduling issues
- Potential Stark or anti-kickback issues
- Structure, composition and ownership of the governing body
- Clinical requirements — does it have a formalized checklist or credentialing process?
- Whether physicians can join another ACO
- How the ACO will market itself and grow
All of these issues present serious long-term operational, financial and legal issues. As such, it is critical for physicians, groups, providers and ACOs to reach out to counsel before entering into any agreement.
We at Lowe & Evander, P.A., are prepared to bring our health care law expertise to review any ACO contract. One of the key components of any ACO is that it needs to have an integrated health information system, electronic medical record health care exchange or both, so that all providers can share information across all patients involved. HIPAA is involved, so one cannot simply give out information without patient approval and authorization.
All of these issues are immensely complex and often counterintuitive. We encourage you to get in touch and schedule an initial consultation as soon as possible.
To schedule an initial consultation with one of our Florida health care attorneys, call (407) 537-0763 or contact us online.