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In Fort Dodge, this is changing. UnityPoint Health (which was, until this week, named Iowa Health System) is one of the 32 Pioneer Accountable Care Organizations that volunteered to have part of their Medicare payments tethered to a set of quality metrics.
While UnityPoint has hospitals across the state, it decided to focus its ACO effort on a relatively small segment of its population to limit the health system’s exposure to the possibility of losing money on the endeavor.
“If we completely missed the mark, we knew it wouldn’t be disastrous from a financial standpoint,” UnityPoint President Bill Leaver said. “We knew it wouldn’t be overwhelming, but a good size to start with.”
The Pioneer ACOs launched Jan. 1, 2012, and for the first year, the program only required them to report quality metrics. Their payments would not yet depend on how well they met 33 measures.
The most difficult part of preparing to move to a system that pays for value rather than volume in Fort Dodge was asking doctors to rethink how they do their jobs. They would be encouraged to delegate relatively routine care, for example, to other advanced practitioners, while focusing their own work on care management.
“That is harder work than we thought,” Leaver said. “For physicians, they run the office and they’re the captain of the ship. Instead of seeing a strep patient now, you might have other people working for you that you’re going to deploy.”
Overall, Leaver describes his experience with the ACO Pioneer program as “generally positive.” What he likes most about the program is that, when the hospital gets a lump sum for each patient, it has more control over treatment. The health system can prescribe treatments that Medicare would not traditionally reimburse.