Palm Beach ACO doctors top nation in Medicare savings

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.

(Getty Images)

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.




Palm Beach docs rock where most fail to share Medicare savings

Dr. Nuria Rodriguez, a member of Accountable Care Options, examines a patient in 2014. (Damon HIggins/Palm Beach Post)
Dr. Nuria Rodriguez, a member of Accountable Care Options, examines a patient in 2014. (Damon HIggins/Palm Beach Post)

Fewer than one in three U.S. doctor groups are managing to share savings with Medicare under a federal program, but Palm Beach County organizations continue to rank as high as No. 2 in the nation for keeping patients happy while avoiding unnecessary costs.

One area doctor says it’s not just about new techniques and data but a heavy dose of “old-fashioned” practices like seeing patients outside conventional business hours or without prior appointments.

Doctors in groups called accountable care organizations are allowed to keep some of the money they save Medicare if they do so while achieving high scores for taking care of patients. Often the savings come from avoiding costly hospitalizations and procedures while focusing intensely on chronic conditions and other patient needs at the primary-care level.

Palm Beach Accountable Care Organization LLC in Palm Springs achieved the nation’s second highest shared savings in 2015, saving taxpayers almost $77 million and keeping $36.8 million of that under the program. Once again, the group serving about 60,000 South Florida Medicare patients trailed only Memorial Hermann ACO in Texas, which achieved shared savings of about $42 million.

Physician CEO Arthur Hansen said he was “proud” of the efffort. Chairman Rohit Dandiya  said it reflects the hard work of physicians who “have invested more time with patients, interacting and educating them to be a partner in their health to improve quality and outcomes.”

That can mean staying open later and seeing patients on short notice without appointments, said Theresa Goebel, medical director for Palm Beach ACO with a Hobe Sound practice. Take a patient with a breathing problem like chronic obstructive pulmonary disease, she said.

“If a patient with COPD has a problem, I might see them that day instead of two weeks later,” she said. The goal: Treatment such as an inhaler in the doctor’s office right away, “so they don’t end up in a hospital emergency room,” she said.

In a way, she said, it’s “going back to what doctors used to do.”

Accountable Care Options LLC in Boynton Beach ranked No. 22 nationally in shared savings with about $7 million, serving about 13,245 Medicare enrollees.

A big goal is coordinated care, avoiding situations where patients go from one specialist to another and “the right hand doesn’t know what the left hand is doing,” said Martha Rodriguez, a doctor in Boynton Beach with Accountable Care Options. “I know in my practice it has worked.”

The Boynton Beach group offers free pill boxes, for instance, and hands-on help for seniors in organizing and tracking medications.

Jupiter-based MCM Acccountable Care Organization LLC served 8,148 patients  and achieved $1.9 million in shared savings for 2015, records show.

Nationally, Medicare accountable care organizations had combined total program savings of $466 million in 2015, federal official said. Out of 392 shared-savings ACOs, 119 qualified for payments from the government, records show.

Medicare accountable care organizations created under the Affordable Care Act have generated more than $1.29 billion in total Medicare savings since 2012, officials said.

“The coordinated, physician-led care provided by Accountable Care Organizations resulted in better care for over 7.7 million Medicare beneficiaries while also reducing costs,” said Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services. “I congratulate these leaders and look forward to significant growth in the program in the coming year.”

The program continues to evolve. Next year Accountable Care Options, for example, plans to participate in a version of the program that lets patients share savings too, officials said. Patients can qualify for a direct payment from Medicare — which can amount to $50 a year — if they stick with ACO-affiliated care in more than half their visits. But the doctors might have to pay the government if they fail to meet program goals.

“It is gratifying to see that providing better care for Medicare recipients has saved U.S. taxpayers hundreds of millions of dollars, and provided incentives for primary care physicians to spend more time proactively monitoring and treating those at risk for chronic conditions,” said Richard Lucibella, CEO of Accountable Care Options.