New Medicare model coming to Middle Georgia

wcrenshaw@macon.comFebruary 2, 2013 

A key part of the Affordable Health Care Act is coming to Middle Georgia.

The region recently was approved for an Accountable Care Organization, to be called the Accountable Care Coalition of Central Georgia. Its aim is to achieve savings by coordinating the care of patients among providers.

More than 10,000 Medicare patients in Middle Georgia are expected to get a notice in February that they are part of the organization. They can opt out of it, and even if they don’t they can still choose physicians outside of it at any time, said Dr. Gerald Brantley, a Perry physician who is the organization’s medical director. There’s no downside to it for patients, he said, and the only question is whether the new model will achieve the savings expected.

The first ACOs were approved in April, and an analysis is being done to determine savings, Brantley said. Physicians in the organization will share the savings with Medicare on a 50/50 basis. The Department of Health and Human Services is projecting a savings nationwide of $940 million over four years.

Savings aside, Brantley said, the organization will mean better care for patients.

“It will give us local physicians an opportunity to be more involved and improve the care for our patients in probably a way we haven’t been able to do in the past,” Brantley said.

For example, if a Medicare patient comes in for a checkup and is found to have diabetes, he said, that patient would need some follow-up care. That would include getting an eye exam every six months because diabetes can lead to blindness.

Previously, the patient would simply be told of the need to get the exam, but the patient might forget or neglect to do it. Under the ACO, there will be a central patient database and an alert will come up that the patient is due for the exam.

One would be scheduled with an eye doctor in the ACO, and the patient alerted. The patient still can choose an eye doctor outside the organization, which goes the same for any other treatment that might be needed.

By better follow-up with patients, the hope is more preventative medicine will head off bigger and more expensive problems later.

“The whole idea is to be as preventative as you can,” said George Trinchitella, senior vice president of Collaborative Health Systems, which is managing the organization.

Collaborative Health Systems is a part of Universal American, which provides Medicare Advantage insurance coverage. The group is managing nine of the 10 ACOs that have been approved for Georgia.

“We believe it is going to be a good thing for the beneficiaries,” Trinchitella said.

The Accountable Care Coalition of Central Georgia includes 50 primary care physicians and 26 specialists. All will work at their current locations.

A total of 250 ACOs have been approved nationwide.

According to a Universal American release, ACOs must meet quality standards “to ensure savings are achieved through care coordination and providing care that is safe, appropriate and timely.” The Center for Medicare and Medicaid Services has established 33 quality measures to monitor the ACOs.

Kathy Floyd, state legislative director for AARP Georgia, said an important concern for AARP is lowering Medicare costs by reducing hospital readmissions. Floyd said ACOs can help with that by ensuring follow-up care after patients leave the hospital.

“If they are done correctly there is potential to provide better care and provide cost savings,” she said. “The potential for upside is really there.”

To contact writer Wayne Crenshaw, call 256-9725.

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