IBJNews

Medicare driving health care hookups

Back to TopCommentsE-mailPrintBookmark and Share

The scramble by local hospitals to form their physicians and facilities into “clinically integrated” networks that can do business with employers and health insurers has another huge motivating factor: Beginning January 2012, they can also do business with Medicare, the massive federal program for seniors.

The new health reform law instructs the Medicare agency to sign new “shared savings” contracts with accountable care organizations, or ACOs. Such an organization must include primary care doctors and must serve at least 5,000 Medicare patients a year.

Many believe ACOs and shared-savings contracts will become the most common way Medicare, the largest and most influential insurance program in the country, does business with hospitals and doctors.

Indianapolis-area hospitals, having recently acquired or affiliated with hundreds of physicians, are now looking to integrate them into one organization for purposes of winning one of the new contracts with Medicare. They also believe the networks can help them negotiate new contracts with employers and private health insurers that reward hospitals for keeping patients healthy, guiding them through the confusing health care system and, thereby, reducing costs.

Hospitals need bonuses to encourage such efforts because the quickest way to reduce costs in health care is to limit hospitalizations.

Community Health Network is probably furthest down this path, with more than 1,000 doctors either working for or contractually committed to working with the network to coordinate care with other providers in an effort keep patients healthy—and having part of their pay depend on it.

“We’ve believed for a very, very long time that the key is to get the physicians and all of the providers on the same page economically,” said Tom Fischer, chief financial officer of Community Health Network. “But we still have for the most part, especially here in central Indiana, a health care system that is driven by providing services, volume of services, as opposed to preventive health care.”

As of June, Clarian Health had hired 415 physicians at the Indiana Clinic, a joint venture with the Indiana University School of Medicine. But the Indiana Clinic has a long way to go to reach its goal of 1,200 to 1,500 physicians.

Meanwhile, Clarian is also trying to sign up its own and independent physicians to its Clarian Quality Partners network, which commits them to integrate their clinical care closer with other Clarian physicians and facilities.

Clarian is launching a new health insurance plan that will rent Clarian Quality Partners access to employers who fund their own health benefits plans.

Meanwhile, St. Vincent Health announced July 1 that its acquisition of Indianapolis-based The Care Group will be the first practice in a statewide network of clinically integrated physicians, similar to Clarian Quality Partners. The St. Vincent Medical Group could serve as a base for an accountable care organization that could win a shared savings contract with Medicare.

“St. Vincent Medical Group is an important entity within our overall strategic provider direction, and affords better coordination and a foundation for physicians to best address wellness for their patients,” Vincent Caponi, CEO of St. Vincent Health, said in a statement.

Physicians don’t all have to sell their practices to hospitals to join these networks; they can sign affiliation agreements that leave them independent or form a joint venture with a hospital system. But experts say the pressure is on physicians to choose a hospital system as soon as possible—even though the rules of accountable care organizations and shared savings contracts have not all been written.

“The 2010 health reform law that created the Medicare shared savings program also appears to limit each physician to participating in only one shared-savings network,” Richard Bouma, a health care attorney at Warner Norcross & Judd, wrote in a June article on the Michigan law firm’s website.

“This one-ACO rule creates an incentive on the part of an ACO network to get physician practices contractually committed to participating as soon as possible, before they join another ACO,” Bouma added. “On the other hand, practice groups likewise do not want to wait too long to join an ACO network, lest a desirable ACO network withdraw its invitation to join.”

ADVERTISEMENT

  • Nice comment
    Dr. Stack, as usual you get to the heart of the matter and unfortunately folks aren't ready- or smart enough- to see the financial disaster coming...
  • cost control??
    anyone who thinks these ACO's and affiliations will control costs needs to wake up. the only cost control mechanism that will work is m.d. and hosp. reimbursement decided by medicare, and elimination of ins. cos. entirely from the mix, i.e. single payer....these measures are simply political compromises, not serious structural economic/financial measures which will bring costs under control....the tidal wave of baby-boomer medicare costs will sink us all.

    Post a comment to this story

    COMMENTS POLICY
    We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
     
    You are legally responsible for what you post and your anonymity is not guaranteed.
     
    Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in IBJ editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
     
    No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
     
    We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
     

    Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

    Sponsored by
    ADVERTISEMENT

    facebook - twitter on Facebook & Twitter

    Follow on TwitterFollow IBJ on Facebook:
    Follow on TwitterFollow IBJ's Tweets on these topics:
     
    Subscribe to IBJ
    1. Uh, sorry Johnnie, but you are incorrect. Despite the assertions by yourself and various defenders and captains, sports attendance is NOT off significantly at most sporting events in the US. Variances in attendance has been in the range of single digits, both + & - for years now. MLB has had most of its best overall attendance nubers in the last decade, and that trend has been consistent for most major sporting events. The number one issue cited by most fans when asked about attendance is the overall cost of attending. The presence of HD and big screen televisions in home doesn't even register, as a factor for not attending an event. VALUE in the product is the key, and apparently is something lacking in the current ICS. What other explanation is there when with what is routinely touted as the "best" racing on the planet, fans are staying away in DROVES. A "close" title battle into the last event at Fontana, with the "cars and stars" of the ICS, and who showed up? MAYBE 8K. Sorry, but HD TV isn't to blame for that kind of fan apathy.

    2. Do you need finance to establish your business ? Are you interested in getting a loan at 3% from our private company? If so please Email: suntrust_oil@blumail.org

    3. If she was worth the $ the public outcry over direct tv dropping them would have kept them on their dishes as we have seen with other companies. I too quit watching channel 13 after she showed up since I left channel 8 because of her all show rather than production results. When Randy on 8 corrected her she had a big head and incorrectly challenged his correction for pronunciation of a city. Other antics while she matures was too much for me with her very inaccurate forecasts. All the forecasters were predicting rain until Thursday except Chris. They predicted sunny on Thursday but instead of rain until Thursday upon which the sun would finally make it out in full glory Chris was right on the money just as I too predicted looking at the radar on weather.gov. One thing I love about Angela is the fear you can see in her every time it thunders in the winter. It far exceeds the entertainment value of her body language (high heel noise drags, depression, etc) when her forecasts are so incorrect. Her hair stands on end, you have to see it!!!

    4. Good Day, Apply For A Loan I am Mr Fernadez Antonio, a private Loan lender and a cooperate financial for real estate and any kinds of business financing. I also offer Loans to individuals, Firms and cooperate bodies at 3% interest rate We offer any kind of loans. email us via fernadezloaninvest@outlook.com LOAN APPLICATION FORM First name:......................... Middle name:......................... Last name:........................................ Date of birth (yyyy-mm-dd):....................... Gender:........................................... Marital status:................................... Total Amount Needed............................... Loan Duration.................................... Address:.......................................... City:............................................. State/province:................................... Zip/postal code:.................................. Country:.......................................... Phone:............................................ Fax:.............................................. Mobile/cellular:.................................. Monthly Income.................................... Occupation:....................................... Best Regard, Mr Fernadez Antonio.

    5. i will love to share my testimony to you all the people in world i got married to my husband about 2 year ago we start having problems at home like we stop sleeping on the same bed,fighting about little things he always comes home late at night,drinking too much and sleeping with other women out side i have never love any man in my life except him. he is the father of my child and i don't want to loose him because we have worked so hard together to become what we are and have today .few month ago he now decided to live me and the kid,being a single mother can be hard sometimes and so i have nobody to turn to and i was heart broken.i called my mom and explain every thing to her,my mother told me about DR.okoro how he helped her solve the problem between her and my dad i was surprise about it because they have been without each other for three and a half years and it was like a miracle how they came back to each other. i was directed to DR. okoro on his email:okorospell@gmail.com and explain everything to him,so he promise me not to worry that he will cast a spell and make things come back to how we where so much in love again and that it was another female spirit that was controlling my husband he told me that my problem will be solved within two days if i believe i said OK So he cast a spell for me and after two days my love came back asking me to forgive him i Am so happy now. so that why i decided to share my experience with every body that have such problem contact Dr okoro the great spell caster on his email addresses spellcasterforlove@outlook.com

    ADVERTISEMENT