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Suiting up for ACO game

Two major Orlando Hospitals and White-Wilson Medical Center in the Panhandle are among dozens of organizations in the state hoping to create alliances and reshape their business models to form accountable care organizations.

ACOs, a centerpiece of the Affordable Care Act, have been touted as a solution to the country's soaring health costs.

“Groups have been slow to start around the country, but the discussion is picking up now,” said Heather Siegel Miller of Broad & Cassel's health law practice.

An ACO is an alliance between health groups that coordinates care for a group of patients within a single health system, integrating records, sharing decision-making and aiming for federal quality benchmarks. Medicare decides which patients will be the ACO's responsibility.

Any government savings—potentially millions in Medicare dollars--would be shared with the ACO.

Most hospitals and health providers decided not to apply for ACO designation under regulations released in March because their requirements seemed burdensome and the incentives too few, Siegel Miller said. In October, the administration released a new, friendlier set of rules and incentives, she said.

“I think now people will be less scared; they will start considering it more now than they did before,” she said.

In certain circles, rumors have swirled for months about who might pioneer the model and possibly reap the shared savings offered by the Centers for Medicare and Medicaid Services.

Most hospitals and doctors continue to play their cards close to the vest, but a few talked to Health News Florida about their plans.

Orlando Health, for example, signed an affiliation agreement with a large primary-care group called Physicians Associates. The two have integrated their medical records and are forming a board that can make decisions about governance, protocols and expenses.

“This could take another three years to get under way, but it's very exciting and I think we have a chance to really improve things,” said Dennis Buhring, CEO of Physician Associates.

Florida Hospital executive Terry Owen said the hospital may form an ACO, but is weighing several partnership possibilities.

"ACO is a model that we are working toward and expect to be performing at; we're not convinced that that's the destination model or the only model," he said.

Florida Hospital has had a long relationship with Physicians Associates, he said, and may work with that group alongside Orlando Health.

The hospital could also improve care by forming partnerships with nursing homes, diabetes clinics or other types of specialty organizations, he said.

"We haven't ruled anything out," he said.

White-Wilson Medical Group in the Panhandle announced as early as January that it would form an ACO as part of a national collaborative through the American Medical Group Association.

Groups cannot yet file official applications because they haven't been released, said CMS spokesman Brian Cook. The government will begin receiving its initial round of applications in January, and the first ACOs are expected to launch in March, he said.

And most groups will be in the preliminary stages for a while to come, said Lisa Grabert, senior policy director at the American Hospital Association.

“This is going to make a small but significant impact at first, but probably more over time,” she said.

Memorial Regional Hospital in Broward, for example, is not looking to climb on board, said spokeswoman Kerting Baldwin.

“Memorial Hospital has always been forward-thinking, but forming an ACO is not the direction we’re going down,” she said.

Even for organizations that would like to form ACOs, it’s tough to get a jump-start, said Owen of Florida Hospital.

It takes money and coordination to decide on protocols and retrain staff to manage care across a continuum of settings, he said.

ACOs are meant to reduce costs and improve quality by weaning physicians and other treatment providers from uncoordinated fee-for-service care, he said. But it's a risky venture in the short term because costs may not go down right away.

"Florida Hospital has been around for something close to 103 years, and we've seen lots of change in healthcare and embrace the need to change again," he said. "But face it. ...just getting the IT systems to do what we want them to is going to be a challenge."

---Health News Florida is an independent online publication dedicated to public-service journalism. Reporter Brittany Alana Davis can be reached at 954-239-8968 or by e-mail.