Specialists Can Get Caught in ACO Web of "Primary Care" and Exclusivity
The definition of primary care under Medicare ACOs is very broad, according to the report. Some services provided by specialists, such as evaluation and management services, can fall under the definition of primary care.
Therefore, a specialist who provides an E&M service that falls under those codes to a Medicare patient who has not seen a primary care physician in a certain time frame could have that patient assigned to him or her, and make his or her group physician practice exclusive to that patient's ACO.
Specialists who wish to participate in more than one ACO must be careful to avoid triggering exclusivity to a Medicare ACO. According to the report, specialists can do this by encouraging their patients to see a primary care physician regularly, along with other options, detailed in the report.
More Articles on ACOs:What's Next for ACOs?
HIT Certification Committee to Develop ACO IT Framework
Florida Blue, Moffitt Cancer Center Form Cancer-Specific ACO
© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.