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A Primer on Accountable Care Organizations Raymund C. King, MD, JD, FICS Law Offices of Raymund C. King, MD, JD, PLLC Plano, Texas TASCS 2013 Annual Meeting – Houston, TX November 8, 2013 Raymund C. King, MD, JD, FICS Law Offices of Raymund C. King, MD, JD, PLLC Plano, Texas TASCS 2013 Annual Meeting – Houston, TX November 8, 2013
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Historical and Projected Number of Medicare Beneficiaries and Number of Workers Per Beneficiary SOURCE: 2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Number of Beneficiaries (in millions)Number of Workers Per Beneficiary
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THE BASICS
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CMS ACO Models Pioneer ACO Model No Longer Taking Applications Only 13 of 32 actually generated any shared savings 9 are leaving the program Medicare Shared Savings Program A program that helps fee- for-service providers become an ACO Advanced Payment Plan Supplemental Incentive Program for selected participants in Shared Savings Program
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How are beneficiaries assigned to an ACO?
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Providers sign agreement to participate with an ACO Patients are assigned to their PCP based on the majority of their outpatient E&M visits PCPs must be exclusive to one ACO Specialists can be part of multiple ACOs These are YOUR existing patients and those of your other ACO members
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THE END Raymund C. King, MD, JD RKing@rkinglaw.com (972) 381-2792 Raymund C. King, MD, JD RKing@rkinglaw.com (972) 381-2792
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