Over the last several weeks, we’ve been in a series discussing Accountable Care Organizations, or ACOs. We began this month by reviewing “What is an ACO and what do you need to know about them?”, and we continued last week by giving some tips to answer the question “Is your practice ready to join an ACO?”.

If you are a primary care practice, you’ve likely been approached within the last few weeks about joining an Accountable Care Organization (ACO), possibly by multiple different groups. The reason for this flurry of activity is Phase 1 of the ACO application program goes from May 18 to June 15, 2023 and the final phase to add TINs to an ACO is July 11 to August 1, 2023. If you’re not already in an ACO, you’ll need to make some important decisions about whether or not to join an ACO for 2024, and which ACO to join. 

McKinsey & Company recently released A REPORT detailing the healthcare industry outlook. With inflation rates and LABOR SHORTAGES, the expected growth for healthcare profits dropped from 6% in the 2021 report to 4%. While outlooks aren’t what they were just a couple of years ago, there are certain sectors that may see higher growth–in particular, Medicare Advantage with payers, which is forecasted to see greater than 10% growth in profits.

The CMS Innovation Center (CMMI) has produced many directives recently, many of which deal with the future of value based care. A 2021 strategy statement summarized the vision of CMMI, with these two statements showing how to measure progress.

The Centers for Medicare & Medicaid Services have advanced value based care significantly in the last several years, and in a somewhat expected, yet bold move in October 2021, specifically said that they expect all traditional Medicare beneficiaries to be treated by a provider in a value-based care model by 2030. CMS rarely uses such superlative terms (all traditional Medicare beneficiaries), and the Centers for Medicare & Medicaid Services Innovation Center (CMMI) has five stated strategic objectives to achieve this massive undertaking.

From the FFS perspective all these yearly patient evaluations add revenue at a relatively higher rate than a typical office visit. A Medicare AWV generates the same work RVU rate as..