The Palm Beach Accountable Care Organization has reported $22 million in savings in its first year, and member doctors received total returns of $11 million—success that the ACO attributes to the fact that it is physician-owned and physician-run.

"Physicians need to run ACOs," said Lenny Sukienik, M.D., the Palm Beach ACO's medical director. "If you have a hospital running an ACO, it won't work."

More than 75 percent of physicians in the ACO are solo practitioners and the organization has no formal hospital affiliation. There are a total of 240 physicians in the network, and 120 are in primary care.

Of the initial 114 ACOs that participated in the Medicare Shared Savings Program, the Palm Beach ACO was one of 29 that exceeded savings projections. When combined with shared savings generated by the other 28 ACOs and parceled out among those ACOs' participants, each member physician's share came to about $63,000.

"Every physician has skin in the game," said Sukienik. The organization cares for about 36,000 patients and includes physicians from Palm Beach, Broward and Dade counties in South Florida.

A recent national survey of public and private ACOs by a research team from the Dartmouth Institute for Health Policy and Clinical Practice found that 51 percent of ACOs were physician-led, while 33 percent were led jointly by physicians and hospitals. And, in 78 percent of ACOs, physicians made up the majority of the governing board.

Farzad Mostashari, M.D., former National Coordinator for Health IT, told Health Data Management that hospital-sponsored ACOs must contend with "demand destruction" on their fee-for-service lines of business if they reduce procedures, admissions and emergency department visits. However, physician-led ACOs are not similarly encumbered, and this model provides them with a "safe" transitional path toward taking risk, said Mostashari.

Established in 2012, the Palm Beach ACO has a three-and-a-half year contract with Medicare. Sukienik said the amount of data shared by CMS regarding Medicare patients was crucial to the organization, including care given to enrolled patients outside the ACO's practice area. Medicare provides the ACO with detailed patient billing data, which physicians can analyze to pinpoint all care received, including ER visits, subspecialist visits or visits outside the practice area.

"The data (analysis) is so important, much more important than we thought," Sukienik said. "It makes a huge difference in how we treat patients. The physician thinks about it in a different way. Medicare patients can go anywhere. A patient could travel to New York and have three COPD (chronic obstructive pulmonary disease) visits and you'd have no way of knowing that."

The Palm Beach ACO's achievements to date were recently featured in an AAFP News article and JAMA commentary.

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