MSSP: Can Providers Participate in Multiple ACOs? By Jennifer Lubell - December 20, 2011
A primary care physician recently had a question for consultant William DeMarco. The doctor had his own practice, but he also worked part time for a clinic and did rounds in a nursing home and had to bill that component for primary care.
In examining the final Medicare Shared Savings Program (MSSP) regulations that came out several months ago, the physician wondered: Was it possible for him to participate in more than one accountable care organization (ACO)?
The answer: It depends on how many tax identification numbers (TINs) the physician uses, says DeMarco, president and CEO of Pendulum HealthCare Development Corp., a management services firm in Rockford, Ill., that builds ACOs for providers.
Nothing has changed since the proposed regulation, which essentially stated that primary care doctors could participate in just one MSSP ACO, DeMarco clarifies. “There’s just a small exception for those primary care doctors” who have more than one TIN.
Doctors would have more than tax ID when they are practicing at different organizations, explains Mike Barrett, senior partner at Ascendent Care LLC, a health care consulting firm in Orlando, Fla., that works with provider groups. “It is possible for a primary care physician during certain times of the week to practice in one group on the west side of town (TIN #1) and a different group on the east side of town (TIN #2) on other days,” he says. For those primary care doctors, participating in more than one ACO could be an option.
But here’s the reality, Barrett continues. “Only a tiny fraction of primary care physicians actually has more than one tax ID,” he says, which means that for the majority of these doctors, the one ACO per doctor rule applies.
Specialists, in the meantime, can participate in more than one ACO, as long as they're not offering primary care services.
What do providers think of the terms of MSSP participation? Have they caused confusion?
ret and DeMarco interviewed by Atlantic Information Services for ACO clarification
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