Is your practice ready to join an ACO?

by Michael Jones

If you are a primary care practice, you’re most likely aware of the CMS directive to have all Medicare fee-for-service beneficiaries in an arrangement that includes accountability for quality and total cost of care by 2030.  You’ve also most likely been approached within the last few weeks about joining an Accountable Care Organization (ACO), likely by multiple different groups, or you’ve done research and heard about ACOs recently. With Phase 1 of the ACO application period of May 18, 2023 through June 15, 2023 and Phase 2 July 11, 2023 through August 1, 2023, being aware of the deadlines is important, but even more important is being prepared to succeed in an ACO, and making the decision to even join one for the 2024 performance year.  

We’ve prepared five questions you need to ask before joining an ACO, which should be helpful as you make your decision to join an ACO. 

Question 1: Is your practice ready to join an ACO at all?

A fundamental question you should ask yourself is - is your practice ready to join an ACO at all? There is a time and resource commitment of being in ACO, on your leadership team, your support team, and on your clinical team. If you are experiencing staffing shortages, upcoming changes in the composition of your practice, an EHR platform change, or anything that could impede your contribution to the ACO, be aware of those items and account for them. The performance year for this cycle is January 1 through December 31, 2024, but there is typically a flurry of activity around the formation of an ACO and the integration of your practice. So first, make the decision early on whether now is the time for you to join an ACO at all. 

Question 2: Do you have the resources and time to commit to participating in an ACO?

Next, you’ll need to decide if you have the resources and time to commit to participating in an ACO. Being a part of an ACO, whether it’s one you start or an existing ACO you join, will require resources and time, typically spent by your leadership team, your support team, and your clinical team. There is compliance training that must be completed, patient notices, and monthly time commitments specific to different ACO groups. Do you have those resources and time to commit?

Question 3: What is your goal for being in an ACO?

The next question you’ll need to ask is - what is your goal for being in an ACO? The leadership and culture of your practice will dictate your goal for being in an ACO, and it’s important to keep sight of those goals. Your goals can be patient care and cost centered, focused on assisting with reporting and support for your practice, revenue, or many other goals. Having clarity on why you want to join an ACO is another important step in your decision making process. 

Question 4: Will you attempt to start your own ACO or join an existing ACO?

Next, you’ll need to decide if you intend to start your own ACO or join an existing ACO. When forming an ACO, the requirements are for the total Medicare beneficiaries to be greater than 5,000, which often is a deterrent to most individual physician practices starting an ACO for their practice alone. Even if your practice alone can meet the threshold of 5,000 Original Medicare beneficiaries, there is a greater risk and difficulty in achieving shared savings with a smaller ACO, and compliance and governance requirements. Joining an existing ACO has a different set of decisions, pros and cons, and questions to ask, which we will review in our next article.

Question 5: Who will be the main point of contact for your practice?

Finally, whether you start your own ACO or join an existing ACO, your practice will need to have a primary contact for maintaining the progress and performance in the ACO. Depending on which route you choose, there can be significant reporting and data requirements, along with attestations and training within the practice. So, having an idea of who your main point of contact is with your practice, should you join an ACO, is important.

These are some basic questions that might help you as you make the initial decision of whether to join an ACO for the 2024 performance year, and are only the beginning. Once you address these questions, you’ll need to choose between the original MSSP ACO structure or ACO Reach, and, if you choose to join an existing ACO, you’ll need to ask some additional questions.

We’ll be guiding you along that path in the upcoming weeks!