Accountable Care Organizations (ACO)
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- Jeffery Hodge
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1 Northwell Health is participating in multiple value based purchasing programs, the aim of which is to reward Northwell Health or the provider for delivering quality patient care. Each of these programs has their own unique regulatory and compliance requirements. Some of these programs include New York s Delivery System Reform Incentive Payment Program known as DSRIP Medicare Share Saving Program Accountable Care Organization, known as the Northwell Health ACO and the Bundled Payments for Care Improvement Initiative. If you work in these areas and have any questions, please contact Corporate Compliance. In 2016, Northwell Health Accountable Care Organization entered into an agreement with CMS to participate in the Medicare Shared Savings Program. The goals of the ACO are to coordinate quality care to ensure that patients, especially the chronically ill, receive the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. 1
2 Under the agreement, the ACO is required to maintain a Compliance Program that is aimed at preventing and detecting incidents related to fraud, waste and abuse. The requirements are very similar to Northwell Health s current Compliance Program. However, we wanted to briefly take a moment to discuss the nuances of the ACO s Compliance Program and risks. It should be noted though that the ACO has adopted a distinct Code of Ethical Conduct. The Code may be viewed on the ACO s website. Questions regarding the ACO s Compliance Program or for more information regarding the ACO s Compliance Policies should be directed to the ACO s Compliance Officer at (516) In addition, the ACO maintains a 24 hour Help Line where you may make an anonymous report by calling
3 CMS requires that ACO providers notify their patients that they participating in an ACO under the Medicare Shared Savings Program. Patients are notified of this through the placement of an approved sign placed in a conspicuous area within the practice. We recommend that the sign be placed in the lobby of the practice. The sign describes what an Accountable Care Organization is, how this may benefit the patient, and information on what the patient must do if they want to opt-out of data sharing between CMS and the ACO. In addition, practices may provide patients with copies of the Beneficiary Information Notice that provides more information about ACOs and care coordination. You should contact the ACO directly at if you need to order the appropriate signage or to request additional copies of the Beneficiary Information Notice brochure. 3
4 An important consideration is how the ACO and its providers interact with patients. Under the Program, Medicare fee-for-service patients continue to maintain the freedom to receive services from providers of their choosing even if the providers are outside of the ACO. However, ACO provider may encourage and explain to the patient the benefits of receiving coordinated care through the ACO. For example, the ACO provider may explain to the patient that receiving a radiology exam from an ACO provider may allow the provider quicker access to the study results. 4
5 Another important aspect of our interaction with patients concerns providing patients with either free or discounted services. In limited circumstances, providers may provide patients with free or discounted items or services if it is related to the patient s care or encourages health awareness. For example, the ACO or its providers may provide patients with blood pressure monitors as a means to encourage the patients to monitor their blood pressure. However, the ACO may never give patients cash or other items unrelated to health care, such as sporting event tickets or gift certificates for non-health care related retail items. Further, the ACO and its providers may not reward patients for either receiving care from the ACO, for staying in the ACO, or as a means to persuade them to remain receiving services from the ACO. For example, the ACO many not generally waive or reduce Medicare co-payments or deductibles. Rule regarding these types of matters are extremely complex. You should reach out to the ACO s Compliance Officer prior to providing any free or discounted items to patients to ensure that they conform to the Program requirements. 5
6 The ACO cannot avoid patients who may drive up healthcare costs. CMS has indicated that they will monitor for patterns that would suggest that the ACO or its providers are steering atrisk beneficiaries away from the ACO. CMS has stringent requirements regarding any marketing materials that the ACO may utilize. CMS s definition is very broad and may include things such as brochures, websites, advertisements, outreach events, letters to beneficiaries, and social media. Where available, the ACO must utilize template language in any of its marketing materials 6
7 In addition to pre-approval, CMS restricts certain language that would suggest that the patient is aligned with a managed care program or that they have enrolled in the ACO program. Similar to other complex issues related to the ACO, you are encouraged to reach out to the ACO s Compliance Officer if you have any questions regarding marketing materials that may pertain to the ACO. The ACO has signed a Data Use Agreement with CMS which allows the ACO to receive patient data directly from CMS to assist it in meeting the goals of the Program. The handling and uses of the patient data under the DUA differ from how we handle protected health information under HIPAA. Specifically, the use of the data is limited to furthering the goals of the ACO and any request must be limited to the minimum amount necessary to achieve the intended goal. Also, the data may not be shared outside of the ACO without the approval of CMS. 7
8 The ACO may receive a portion of any shared savings based upon the accurate data that it is required to submit to CMS. Under the Program, the ACO is required to retain all records related to the ACO for a 10 year period from the completion of its involvement in the Medicare Shared Savings Program. As a result, this may differ from other record retention requirements that you may have and care should be taken not to destroy any data that may be relied upon by the ACO in its reporting efforts. We appreciate that there are a lot of nuances that relate to our participation in the ACO program. However, your involvement in the Compliance Program is vital. Under the Medicare Shared Savings Program, the ACO is obligated to report probable violations of law as it relates to our involvement in the Program. Although it can be daunting task to participate in a Compliance Program, at the end of the day we are all responsible for ensuring that we are delivering excellent patient care that conforms to the rules and regulations that set forth by various government regulators. 8
9 Examples of things that should be reported to the ACO Compliance Officer include any allegations of fraud, waste or abuse related to or impacting the ACO operations, government investigations or inquiries concerning the ACO, patient privacy concern, potential conflicts of interest, patient complaints alleging inappropriate behavior of ACO providers, suspected violations of the ACO s Code of Ethical Conduct, and any other compliance concern. Noncompliance may lead to serious consequences, including the termination of the ACO s contract with CMS, repayment of substantial amounts of funding, and possibly, civil and/or criminal penalties for serious violations. The ACO s Board of Managers has adopted a strict policy of non-retaliation in the ACO s Compliance Program. 9
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