A doctor group based in Palm Beach County leads the country in saving taxpayers money while meeting goals for keeping Medicare patients happy and healthy.
Palm Beach Accountable Care Organization based in Palm Springs saved taxpayers $62 million and was allowed to keep $30 million of that for 2016 because it earned high scores for patient health and satisfaction, according to federal officials. The group ranked No. 2 nationally in shared savings a year ago.
“We’re keeping our patients healthier and out of the hospital,” said board chairman Richard Weisberg. “The savings are good and we’re proud of those. Keeping patients healthy is most important.”
The group of 275 primary-care doctors and 175 specialists serves 69,000 Medicare patients from St. Lucie County to Miami-Dade County.
Others in the region stood out as well. Ranking No. 10 in the nation for shared savings was Orange Accountable Care of South Florida, based in Miami Lakes and serving patients in counties including Palm Beach. It saved Medicare $28.6 million and earned $13 million.
It’s no simple task. Out of more than 400 Medicare “accountable care” organizations nationwide, about one in three shared savings with the federal agency. Program savings amounted to $652 million, according to a spokesman for the Centers for Medicare and Medicaid Services.
The program represents one of several efforts in recent years to make federal spending more efficient while rewarding providers who get high marks for patient care.
Not everyone is a fan of the concept. West Palm Beach attorney Ted Babbitt casts a skeptical eye toward assurances patient needs will always come first.
“Any time there is financial incentive to reduce care I am concerned for both patient care and physician liability,” Babbitt said.
But ACO officials argue the program provides incentives to offer more attention, not less, at the primary-care level. That can mean seeing patients on short notice, at unusual hours or several times in a week — if it helps patients control a chronic condition such as diabetes and avoid a more costly trip to the hospital.
For example, ACO doctors might pay special attention to factors such as the body weight of a patient at risk of congestive heart failure, said Palm Beach ACO board member Daniel Boss.
“I have a nurse who’s calling frequently, to make sure the weight’s not going up,” Boss said.
If signs point to a potential problem, “we can intervene,” he said. That can mean bringing the patient to the office for diuretics to help the body pass fluids more quickly, he said.
Under the traditional fee-for-service system, doctors have been paid by how many services they performed, not by the health outcome of the patient, ACO supporters say. If patients went to the emergency room, primary-care doctors had no particular financial reason to be concerned if the hospital repeated expensive tests they had already done.
To share savings, ACOs must get high scores measuring patient health and satisfaction. If patients don’t think they are being treated well, they can choose other doctors at any time. The spending is measured against what Medicare spent on the patients in the past.
Early versions of the program have split savings roughly in half between Medicare and ACOs, though a shift to newer models increases rewards but also puts ACOs at risk of paying the government if they fail to achieve their goals.
Accountable Care Options in Boynton Beach, serving 11,500 patients, said it achieved gross savings of $10.2 million in 2016 and was allowed to keep 75 percent of that, said CEO Rich Lucibella. That ranked No. 3 in the nation for its particular “track,” or version of the program, he said.
One challenge is how to account for unexpected events like storms, which can disrupt normal care, he said.
“What about Hurricane Irma?” Lucibella said. “They’re benchmarking us against years without a major hurricane.”
Getting the rules right can matter a lot to the program’s future. A federal spokesman noted agency officials have asked for feedback on a variety of initiatives, including ACOs, that are designed to promote efficiency while giving consumers more information and options.
“CMS supports efforts to shift from a fee-for-service system that reimburses only on volume and towards a value-based payment system that rewards improving outcomes,” the spokesman said.