Rivera is a patient of PrimeHealth Physicians, which applied for federal approval as an ACO in July. A decision from the federal Centers for Medicare & Medicaid Services is expected in the fall.
The group of 30 physicians 26 are co-owners was created by Riveras primary care physician, Dr. Diego Saavedra, who said he wants to remain independent rather than be forced into a hospital network or another ACO.
We just dont want to get swept up and let big institutions decide when and where and how we should deliver care, said Saavedra, chairman of the PrimeHealth network that includes 18 doctors offices from downtown Miami to Homestead, with most of the physicians located in Kendall.
Nationally, there are about 250 ACOs that participate in Medicares shared savings program, with 28 of those organizations based in Florida, though ACOs from different states also serve beneficiaries in the Sunshine State.
Florida is a natural for ACOs, Goodman said, given the states large population of elderly residents, and because in order to qualify as an ACO, a group must agree to manage the healthcare needs of at least 5,000 Medicare beneficiaries
The concept is especially important for patients in Miami, where the average Medicare beneficiary has close to the countrys highest costs. Studies by Dartmouth Atlas researchers have shown that Miamis Medicare beneficiaries frequently receive duplicate tests and treatments from specialists who failed to coordinate care.
ACOs may help limit such overuse of tests and treatments by relying more heavily on electronic medical records to improve communication among providers and patient; and by changing the way physicians and other providers are reimbursed, from a fee-for-service model that pays for each individual medical procedure, to bundled payments to be split by doctors, hospitals and other caregivers.
Goodman, the FAU healthcare law teacher, anticipates that dividing that pie will test the commitment of all the providers involved to coordinate patient care and continue as an ACO.
Thats the rub, she said. Youve got to get people to play well together.
Saavedra said he welcomes the change in payment system because the fee-for-service model pressures physicians to increase volume, which can affect the quality of care, whether its reducing the time doctors spend with patients in the examination room, or failing to provide incentives for physicians to follow up.
Theres a breaking point there where your quality suffers, Saavedra said. You cant see 70 patients a day and practice good medicine.
Saavedra said he and two other physicians who share an office typically see 20 to 25 patients a day.
Start-up costs include significant investment in computers and software to manage electronic medical records that will allow physicians to collaborate, and the groups to report data on costs and patient health as required by Medicare.
Cesar Ortiz, chief executive of PrimeHealth, said one big difference between the HMOs introduced about 20 years ago and the new ACOs is the technology to hold providers accountable for the coordinated care.
All of the physicians in PrimeHealth have agreed to share their back office infrastructure, he said, spreading the cost among the group.