December 19, 2011

Texas Health Resources, North Texas Specialty Physicians to participate in health effort

The federal program, which is designed to cut costs, will treat Medicare patients using a collaborative system called an Accountable Care Organization.

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Texas Health Resources, one of North Texas' largest hospital groups, and North Texas Specialty Physicians said Monday that they will participate in a new federal effort to treat Medicare patients using a collaborative system called an Accountable Care Organization.

Arlington-based THR and the Fort Worth-based physicians' group are among 32 organizations nationwide that will operate under Medicare's Pioneer ACO Model, which aims to provide more-coordinated care at lower cost.

THR and the physicians' group said they already use a health information exchange that allows them to share patient records electronically. The only other Texas party in the Pioneer program, whose participants were officially announced Monday, is Seton Health Alliance in Austin.

The ACO approach is mandated by the Affordable Health Care Act, the big federal measure that passed last year. An ACO agrees to accept financial responsibility for the Medicare beneficiaries its members treat. Under one option that includes sharing in gains or losses, depending on whether medical expenses met budget, and under another option there is a fixed per-capita amount per beneficiary, a system called capitation.

The Center for Medicare and Medicaid Services said Monday that it expects the initiative to save more than $1.1 billion over the next five years.

Health and Human Services Secretary Kathleen Sebelius, in a statement, said "Pioneer ACOs are leaders in our work to provide better care and reduce healthcare costs."

Barclay Berdan, senior executive vice president at THR, said the wider use of electronic medical records today is one of the advances separating the ACO model from the controversial, HMO-driven capitation models of the 1990s.

Berdan said ACOs "are in effect redesigning care," giving doctors and hospitals a better way to deliver care on a budget by making available a patient's complete medical history, including prescriptions.

Karen Van Wagner, executive director of NTSP, which has more than 600 family and specialty doctors, said her group has experience with managing medical costs as a longtime participant in Medicare Advantage programs, which function like HMOs. She said the Pioneer ACO program will have two years of "savings sharing," as Medicare terms it, followed by a move to capitation by ACOs that show savings.

Van Wagner said NTSP currently treats about 35,000 Medicare Advantage patients and expects to add another 20,000 Medicare patients as part of the ACO.

Jim Fuquay, 817-390-7552

Twitter: @jimfuquay

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