Thursday, September 19, 2013

More charges filed against cancer specialist Fata

More charges filed against Dr. Fata

Rochester Hills, Mich. (WXYZ) - A grand jury hands down 13 new charges on a Detroit-area cancer specialist accused of giving unnecessary treatments to patients.
The new charges against Dr. Farid Fata include fraud, conspiracy to receive kickbacks and fraud during the citizenship process. Dr. Fata has been in custody for six weeks  A judge will consider lowering his bail at an Oct. 2 hearing.
7 Action News spoke with a patient's wife who believes they were victims of the kickback scheme.
Two days before 66-year-old Larry Hicks died from lung cancer, Dr Fata threatened to stop treating him said his wife Donna Hicks.
“I was in a state of shock.  I couldn’t believe a doctor would do that, especially in the presence of a dying patient,” said Donna.
Donna moved out of state after her husband died in 2010.  She said she they told Dr. Fata they wanted to use Hospice of Michigan, but Dr. Fata would not hear it, and wanted them to use the services Guardian Angel Home Care.
“He said, well you should have gone with guardian angels because they know him.  And he said, well, if this what you want, then I can’t be his doctor anymore,” said Donna.
According to federal authorities, Dr. Fata referred patients Guardian Angel Home Care, Inc. in exchange for kickbacks on three separate occasions totaling $3,000 dollars.
“False.  100 percent false,” said Ziad Kassab, Vice President of Guaridan Angel Home Care, Inc.
7 Action News spoke with Kassab at the company’s headquarters in Rochester Hills.   
“We are hurt.  These allegations are not true at all.  Please don’t believe what you’re hearing,” said Kassab.
Kassab refuted all of the allegations in the indictment and said that Dr. Fata was one of about a dozen medical directors.  He only held the position for maybe one year and patients could choose to go where they wanted for home care services.
“We’re surprised as everyone else.  We didn’t know anything about his practices or allegations until we saw it on TV,” said Kassab.
The kickback allegations are just one portion of the new charges.  The federal government said that at least four of Dr. Fata's patients being treated for cancer did not have cancer.
The government said one patient who did not have cancer had 155 chemotherapy treatments.
Federal authorities from the beginning have said that Dr. Fata misdiagnosed patients and ordered unnecessary treatments to make money off of Medicare and other insurance programs.
Fata could lose his U.S. citizenship if the government proves he was committing health fraud when he applied in 2008.
Dr. Fata's attorney Mark Kriger would not talk on camera about the charges but told 7 Action News by phone, “I do not believe it is appropriate to comment on pending cases. I believe the appropriate forum is the courtroom."
Attorney's for victims of Dr. Fata and families of victims have an open meeting at the Concorde Inn in Rochester HIlls Thursday from 5 pm-8 pm.

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Community-Oriented Pediatric Medical Homes

Dr. Genevieve Daftary, Pediatrics Department | 9/15/2013, noon

A pediatric patient and his mother talk with a medical assistant at Codman Square Health Center. CODMAN HEALTH SQUARE
A Special Advertorial Section
What does a patient centered medical home (PCMH) look like within primary care pediatrics? What is needed from a pediatric- centered medical home within the context of an urban community health center like Codman Square? Our health center achieved the highest tier of recognition from the National Committee for Quality Assurance in 2012, reflecting our commitment and organizational capacity to provide care that is coordinated, patient centered and responsive to health of the population.
The process of achieving PCMH recognition was a reminder that children are not little adults. Our pediatric population struggles with the affects of asthma, obesity, sickle cell disease and attention deficit disorders, all considered chronic medical conditions within children. However, the management of these conditions and the more common issues affecting children and young adults of language delay, school and learning problems, high risk sexual behaviors, drug use and mood disorders do not typically fit well in the model of chronic disease management and episodic health care encounters that has been used in adult settings. If our aim is to be patient centered, how do we design a medical home that addresses these very important needs of the youngest members of our community?
It is interesting to revisit this question when one considers that the American Academy of Pediatrics (AAP) released one of the earliest concepts of patient centered medical home in its 1992 policy report on Medical Home. “The AAP believes that the medical care of infants, children and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated and compassionate.”
This initial policy statement grew out of almost 30 years of work by the AAP on addressing the care of children with special health care needs (CSHCN) and went on to inform more contemporary versions of this concept. This concept of the medical home was revised and expanded on by a coalition of the AAP, the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association in 2007 and released as the Joint Principles of the Patient Centered Medical Home. Ultimately the Agency for Healthcare Research and Quality definition emerged and has largely been used to make decisions about accreditation.
While PCMH emerged from pediatrics and the care of CSHCN, the large majority of pediatric patients, both in our population and more broadly, do not have complex medical needs but do have complex social, developmental and psychological needs that have a large impact on their overall wellness now and in the future.
At Codman Square Health Center we have begun to structure a broader community-oriented perspective on patient-centered medical homes for children. We have done this internally using group visit models for children between birth and one year that emphasize shared community and parenting experiences and allow more time with providers to focus on anticipatory guidance. Additionally, we have incorporated the Project LAUNCH program into our support services for families most in need.
This federal grant has allowed us to have a family resource specialist and an early childhood development specialist available within the health center to support those families and children we identify as being most in need of parenting support, behavior coaching, child care resources and developmental assessments and support. These specialists have performed home and school visits, coordinated resources for families whose children are being evaluated for autism and helped coach young families struggling with homelessness, unemployment and single parenthood.
Externally, we have cultivated strong relationships with schools, recognizing that after early childhood, schools become not just the places where children spend most of their waking hours but also micro-communities that serve as a way to engage with students and parents around a variety of health and wellness topics. We enjoy being a resource for consultation on school health policies and programs, a referral resource for health services and an on-site provider of care.
Our longest and strongest partnerships have been with Tech Boston Academy, where one of our nurse practitioners runs a school-based health center, and Codman Academy Charter Public School, the first and only co-located school within a health center in the country. These relationships with schools fit into a belief that integrating education and health care can achieve real community wellness through the reversal of the effects of systemic poverty. As we work with these and other school partners, we are looking to build systems to promote the growth of healthy children who will go on to be leaders of healthy communities. It is a vision for a new patient-centered approach that we are excited to be a part of building.
Codman Square Health Center
637 Washington St, Dorchester, MA 02124
617-825-9660 |

Gentiva® Health Services to Acquire Harden Healthcare

- Increases Focus on Dual Eligible Population

- Combines Leading Home Health, Hospice and Community Care Providers

- Company To Host Call Today at 9:00 a.m. ET

ATLANTASept. 19, 2013 /PRNewswire/ -- Gentiva Health Services, Inc. (NASDAQ: GTIV) ("Gentiva" or "the Company"), the largest provider of home health and hospice services in the United States based on revenue, and Harden Healthcare Holdings, Inc. ("Harden"), a leading provider of home health, hospice and community care services, announced today that they have entered into a definitive merger agreement whereby Gentiva will acquire Harden.    
Under the terms of the merger agreement, Gentiva will acquire Harden's home health, hospice and community care businesses. Harden's existing shareholders will retain the company's long-term care business.   The purchase price to be paid by Gentiva is approximately $408.8 million, consisting of $355 million in cash and approximately $53.8 million in Gentiva common stock.  Gentiva expects to fund the cash portion of the purchase price through available cash and a new credit facility.  The Company expects to raise a new $855 million term loan facility to fund the transaction and refinance its existing term loans.      
Founded in 2001 and based in Austin, Texas, Harden operates in 13 states and has a large presence in Texas and several other south central states.  Excluding its long-term care business, Harden's 2012 consolidated revenue was approximately$476.0 million.  
Based on results from continuing operations for the respective companies' 2012 fiscal years, we anticipate the combination of Gentiva and Harden will create a company with revenue comprised of 49% home health revenue, 41% hospice revenue and 10% community care revenue.  The percent of combined company Medicare revenues for the full-year 2012 would have been 72%, down from 86% for standalone Gentiva, thereby reducing the Company's Medicare exposure.
As part of the transaction, Gentiva will become a preferred provider for Harden's 49 skilled nursing and assisted living facilities in Texas.
"This transaction is a great strategic fit for Gentiva and we believe it will provide significant long-term value for our shareholders," commented Gentiva Executive Chairman Rod Windley. "I consider the Harden transaction a milestone in the continued Gentiva growth story.  The increasing healthcare needs of an aging population and ongoing rate pressures will fuel industry consolidation and Gentiva is positioned to be a leader in this effort.  Additionally, I am pleased to announce that current Harden Chairman Steve Hicks will be joining the Gentiva board at the completion of the merger."
"We are excited to welcome the Harden employees to the Gentiva family," said Gentiva CEO Tony Strange.  "Harden is recognized as a leader in the post-acute care continuum for seniors and shares our commitment to quality outcomes, customer satisfaction and employee engagement, all done in an environment of compliance.  In addition to further strengthening our core home health and hospice businesses, this acquisition expands Gentiva's service offerings into the dual eligibles, which is one of America's most frail populations and a key priority for federal and state governments as they seek better coordination of care, reduced costs and improved outcomes.  We believe the combination of these two companies uniquely positions us to provide pre- and post-acute care services in the markets we serve."
Harden CEO Lew Little added, "This merger represents an exciting opportunity to bring together two complementary companies that share a commitment to providing compassionate care and we look forward to better serving our patients and their families with the expanded resources of the combined company."
The transaction was approved by the Board of Directors of each company and by Harden's shareholders. The transaction is scheduled to close in the fourth quarter of 2013 and is subject to customary closing conditions. 
The Company expects the acquisition to be accretive to adjusted income per share, exclusive of one-time costs, within the first 12 months following closing. Assuming the transaction closes in the fourth quarter of 2013 as expected, the Company expects combined 2014 revenues to be in the range of $2.1 billion to $2.2 billion and Adjusted EBITDA to be in the range of $210.0 million to $220.0 million, excluding the impact of equity-based compensation expense.
Edge Healthcare Partners, LLC, a division of Edge Corporate Finance, LLC, is acting as financial advisor to Gentiva.  Greenberg Traurig, LLP is acting as legal advisor to Gentiva.  Barclays and BofA Merrill Lynch have provided committed financing for the transaction.  
Barclays is acting as financial advisor to the Board of Directors of Harden.  Alston & Bird LLP is acting as legal advisor to Harden.
Non-GAAP Financial Measures
The information provided in this press release includes a non-GAAP financial measure, Adjusted EBITDA. Adjusted EBITDA excludes charges related to restructuring, legal settlements, acquisition and integration activities and other special items.  Management uses Adjusted EBITDA to compare operating results with other companies in the healthcare industry.  Adjusted EBITDA should not be considered in isolation or as a substitute for the comparable GAAP measure.
A reconciliation of Adjusted EBITDA to net income attributable to Gentiva shareholders, the most directly comparable GAAP measure, is not accessible on a forward-looking basis without unreasonable effort due to the inherent difficulties in predicting the costs of restructuring, legal settlements and merger and acquisition activities and the impact of any future acquisitions or divestitures, which can fluctuate significantly and may have a significant impact on net income.
Conference Call and Webcast Details
The Company will comment further on this transaction during a conference call and live webcast to be held Thursday, September 19, 2013 at 9:00 a.m. Eastern Time. To participate in the call from the United StatesCanada or an international location, dial (973) 935-2408 and reference call #68479531. The webcast is an audio-only, one-way event. Webcast listeners who wish to ask questions must participate in the conference call. Log onto to hear the webcast. A replay of the call will be available on September 19 and will remain available continuously through September 26. To listen to a replay of the call from the United StatesCanada or international locations dial (800) 585-8367 or (404) 537-3406 and enter the following PIN at the prompt: 68479531. Visit to access the webcast archive. This press release is accessible at and a transcript of the conference call will be posted on the Company's website.
About Gentiva Health Services, Inc.
Gentiva Health Services, Inc. is the nation's largest provider of home health and hospice services based on revenue, delivering innovative, high quality care to patients across the United States. Gentiva is a single source for skilled nursing; physical, occupational, speech and neurorehabilitation services; hospice services; social work; nutrition; disease management education; help with daily living activities; and other therapies and services. GTIV-G
Forward-Looking Statements
Certain statements contained in this news release, including, without limitation, statements containing the words "believes," "anticipates," "intends," "expects," "assumes," "trends" and similar expressions, constitute "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are based upon the Company's current plans, expectations and projections about future events. However, such statements involve known and unknown risks, uncertainties and other factors that may cause the actual results, performance or achievements of the Company to be materially different from any future results, performance or achievements expressed or implied by such forward-looking statements. These factors include, among others, the following: economic and business conditions; demographic changes; changes in, or failure to comply with, existing governmental regulations; the impact on our Company of healthcare reform legislation and its implementation through governmental regulations; legislative proposals for healthcare reform; changes in Medicare, Medicaid and commercial payer reimbursement levels; the outcome of any inquiries into the Company's operations and business practices by governmental authorities; compliance with any corporate integrity agreement affecting the Company's operations; effects of competition in the markets in which the Company operates; liability and other claims asserted against the Company; ability to attract and retain qualified personnel; ability to access capital markets; availability and terms of capital; loss of significant contracts or reduction in revenues associated with major payer sources; ability of customers to pay for services; business disruption due to natural disasters, pandemic outbreaks, terrorist acts or cyber-attacks; availability, effectiveness, stability and security of the Company's information technology systems; ability to successfully integrate the operations of acquisitions the Company may make and achieve expected synergies and operational efficiencies within expected time-frames; ability to maintain compliance with its financial covenants under the Company's credit agreement; effect on liquidity of the Company's debt service requirements; and changes in estimates and judgments associated with critical accounting policies and estimates. For a detailed discussion of certain of these and other factors that could cause actual results to differ from those contained in this news release, please refer to the Company's various filings with the Securities and Exchange Commission, including the "Risk Factors" section contained in the Company's annual report on Form 10-K for the year ended December 31, 2012.
Financial and Investor Contact:
Eric Slusser
John Mongelli
Media Contact:
Scott Cianciulli
Brainerd Communicators

Healthy innovation

Published: Wednesday, September 18, 2013 at 3:02 p.m.

Photo by Ken Blevins
Jeff James is the CEO of Wilmington Health.
Jeff James can see clearly now, and it’s a beautiful thing. “I’ve never been more excited about the future of health care, and I’ve been doing this for over two decades,” says James, the dogged and innovative chief executive officer of Wilmington Health. “We are working here to integrate the providers and payors and hospitals.
“If we do it right, Wilmington is going to be a destination for health care.”
Looking in the rear view mirror, though, James was more apprehensive than excited.
James was chief financial officer at the Shannon Clinic (the provider) in San Angelo, Texas, where, typically, the doctor roster doubled and care expanded as he worked endless hours to grab market share, outdo the competition and beat up on the insurance companies (the payors). Then, in the late 1990s, along came his first child, a daughter.
“And I just couldn’t imagine how I was going to explain to my little girl what I did for a living,” says James. “I didn’t just mean all the absences at home because of work, but what were we really accomplishing. I said, ‘No, I’m not going to continue to do that.’ So I flipped from being a competitor to a physicians’ advocate
“We’re working to change the landscape so across the health-care continuum we can collaborate together to become trusted, transparent partners in the community.”
If you think it’s just bluster, get this: “I actually tell insurance companies how to pay Wilmington Health less.” Or, “We have a terrific economy of scale on purchases of supplies, but we let independent doctors in the area get their supplies through us so they can save money.”
James, now nearing 50, is just getting started, so if you want to peek into his future paradigm of community health care, please take a seat and buckle up.
First, some background.
He was a Marine for four years, including two years at Cherry Point, where “I fell in love with coastal Carolina,” developed his competitive edge and got his future college tuition covered. That paid for five years at Eastern Illinois University, in his native state, ending with a master’s in business administration.
This was the early 1990s, James signed up for a pilot program in Illinois to tackle and solve numerous state issues, especially saving money. Teamed with an MBA from Harvard and another from DePaul, James’ assignment was whether to privatize the state’s far-flung motor pool, with its thousands of vehicles, mechanics and garages.
“Both from a cost and efficiency standpoint,” remembers James, “our research showed that it was absolutely clear that turning it all over to a private company made sense. But politics and the bureaucracies got hold of it and ignored our recommendation. We couldn’t impact change.
“So I pointed out to the state another waste of money: me,” says James, “if they weren’t going to listen to our recommendations.”
His wife, Liz, pointed him to the health care industry, and he signed on with a 10-doctor orthopedic group in Springfield, and, sans political intervention, he began to thrive in a profession he had never considered.
“It was a relatively small practice, but I learned health care from the ground up,” says James. “It taught me how competitive health care could be. The growth was focused on growth. And beating the competition. I was a Marine, a Type-A. Worked for me.”
But down in Texas a few years later, just thinking about how to explain himself at “bring-your-parent-to-school day,” Jeff James had his epiphany.
“It was a complete 180,” he says.
And when he was hired in 2008 to come to coastal Carolina and run Wilmington Health, which is 100 percent independently owned by its physicians, including those on its board of directors, James found the perfect landscape to test his theories of collaboration, transparency and trust between the triad of health-care provider, payors and hospitals.
With white boards and posters along the Wilmington Health office corridors on Medical Center Drive, pounding home the mission of everyone rowing in the same direction – especially a medical cadre that has doubled in size to 150 people practicing at 21 locations since his arrival – James is determined to make Wilmington Health a trusted partner in health care and service.
He has champions across the landscape here, including Paul Snyder, the CEO of Glen Meade Center for Women’s Health, who could have been a nay-saying competitor:
“Jeff truly wants to transform the delivery of health care in Wilmington and the surrounding counties,” says Snyder. “He knows Wilmington Health cannot do this without the involvement and support of other key players in the health-care community. (So) he’s always been very transparent and welcoming of all constituents to the table – the major insurance companies and hospitals, down to single specialty practices.
“Success for Jeff is not simply driven by improving the quality and value of health-care delivery at Wilmington Health; rather, he wants all providers to be a part of this rising tide so that health-care consumers across the market place benefit. Wilmington needs advanced health-care thinkers like Jeff James.”
James’ transformation came on two levels: the waning of his competitive streak and the wooing of physicians.
“I realized down in Texas, market share and fighting the competition was ‘scarcity thinking.’ You were taught there was this small pie and you have to fight for your piece of it. Or pieces of it. And if somebody got a piece of it, you were losing. So for you to do better, somebody else has to do worse.
But I came across ‘abundance thinking.’ Guess what? The pie can be infinite. It can grow. As you get better, you let others know how to get better. It’s especially true in health care. The better we all are, the more people will come to Wilmington for health care and the more people will stay.”
 A big cog in James’s triad of collaboration was the doctor. But now, as much as CEO, he actually is proudest of his title: physicians’ advocate.
“In the past, the doctors were the problem to collaboration and integration,” says James. “But they also are the solution. Doctors are trained to be independent, and by nature they are very competitive. Physicians are the only fragmented piece of the health-care industry – there are hundreds of independent practices. But as they do come to group practices, it allows us to finally, clinically integrate.”
He often has meetings well before the crack of dawn or late into the evening with independents who want to test the Wilmington Health waters.
James also firmly distinguishes between collaboration, his touchstone, and consolidation, which, in his view, simply raised costs for patients and payors by grouping tests and services under one roof, inflating prices.
The new paradigm works best if all parts of the triad support transparency to the consumer and the payor around quality cost and the patient experience. James believes that new technologies allow for information contained within the Electronic Medical Record to be married with information contained in claims files from providers to give a clear picture of which providers can provide true value.
James: “True value is the intersection of cost and quality. This provides a legitimate scorecard of the performances of all involved in health care.
“Transparency is the catalyst for this major new health-care model,” James continues. “Historically, all we have had are anecdotal representations of patient experiences as the surrogate for quality, like how long you were in the waiting room. But that’s about to change. Informed choices will be possible and will drive true innovation that will decrease cost and improve clinical outcomes for the patients.”
His daughter, now a straight-A student at New Hanover High, or his 8-year-old son, can now have Dad over to school for show-and-tell, and he won’t melt. In fact, he’ll probably start right in with a message for the sophomores or the third-graders: collaborative, transparent health care, where patients can monitor and track the outcomes of their docs, is coming to Wilmington, and it’s going to bring more and more patients with it.
“The Mayo Clinic,” says James, “it never, in any presentations or speeches or literature, talks about market share. It only talks about quality of care. And here in Wilmington, I think you’re going to see that all of us (providers, payors, hospitals) are going to play the game with our cards face up.
“That’s how we’ll develop trust to make this a health-care destination.”

GreatCare Home Health CEO to Pay $15 Million for Medicare Fraud

Hee Jung "Angela" Mun of Rancho Palos Verdes operated GreatCare Home Health Agency.
The owner of a home health agency was ordered to pay nearly $15 million—about three times the losses suffered by Medicare as a result of a kickback scheme she masterminded, federal prosecutors announced Wednesday.
U.S. District Judge Stephen V. Wilson's $15 million default judgment against Hee Jung "Angela" Mun of Rancho Palos Verdes resolves a whistleblower lawsuit filed by the agency's then-receptionist, according to the U.S. Attorney's Office.

The judgment against Mun and the conclusion of the lawsuit were announced Wednesday when the U.S. Marshals Service transferred to the U.S. Treasury more than $1 million seized in March 2011 when federal agents executed a search warrant at GreatCare and seizure warrants on the bank accounts of both the agency and Mun.Mun, 51, is a former registered nurse who owned and operated GreatCare Home Health Agency in the Westlake district of Los Angeles.
GreatCare paid kickbacks to physicians and others to induce them to refer patients to the agency in a $5 million Medicare fraud scheme, prosecutors said.
In a related criminal case, Mun pleaded guilty to federal health care fraud charges and is scheduled to be sentenced in February.
The scheme targeted elderly and primarily Korean Medicare beneficiaries, according to federal prosecutors.
The case came to light in March 2010 when the receptionist filed a lawsuit on behalf of the U.S. government naming as defendants GreatCare; Mun, the company's owner/director; three physicians; a physical therapist and several licensed nurses; and other unlicensed persons employed by the agency.
—City News Service.

SHARP’S MEDICARE EXPERIMENT Health system sticks with program that rewards providers who keep costs down without hurting quality


Health system sticks with program that rewards providers who keep costs down without hurting quality

Pioneer Accountable Care Organizations nationwide
Alina Health, Minnesota and Wisconsin
Atriums Health, Massachusetts
Banner Health, Arizona
Beacon, Maine
Bellin Thedacare Healthcare Partners, Wisconsin
Beth Israel Deaconess Physician Organization, Massachusetts
Brown & Toland Physicians, San Francisco Bay Area
Dartmouth-Hitchcock ACO, New Hampshire and Vermont
Fairview Health Systems, Minnesota
Franciscan Alliance, Indiana
Geneses PHO, Michigan
Heritage California ACO, California
Michigan Pioneer ACO, Michigan
Monarch Healthcare, Orange County
Montefiore ACO, New York
Mount Auburn Cambridge Independent Practice Association, Massachusetts
OSF Healthcare System, Illinois
Park Nicollet Health Services, Minnesota
Partners Healthcare, Massachusetts
Renaissance Health Network, Pennsylvania
Sharp Healthcare System, San Diego County
Steward Health Care System, Massachusetts
Trinity Pioneer ACO, Iowa
Source: Centers for Medicare & Medicaid Services.
Though it has not yet recouped its initial investment, Sharp HealthCare is sticking with a new government program that rewards health systems if they can deliver quality care at a lower cost.
On Jan. 1, 2012, Sharp was one of 32 “pioneer” health systems nationwide selected by the Centers for Medicare and Medicaid Services to participate in its new accountable care organization program.
The three-year pilot initiative seeks to reduce spending on beneficiaries by offering health systems a cut of any savings earned, but it also asks each participant to share the financial pain if they spend more than expected caring for patients.
Alison Fleury, Sharp’s senior vice president of business development, said Medicare designated 27,894 beneficiaries as part of the organization, calculating that it would expect to spend about $320 million on those patients in 2012.
Fleury said that in its first year of operation, Sharp’s actual expenses on those patients was 0.3 percent higher than the benchmark. The system would have needed to see costs shrink or grow by at least 2 percent to receive a share of savings or pay a share of the losses.
“Basically, we broke even,” Fleury said. “We had no loss, and we had no gain.”
San Diego County is also home to two other accountable care organizations run by Tri-City Medical Center in Oceanside and a group of doctors in the southern and eastern parts of the county. These two organizations, however, are part of a different Medicare program that has not been in operation as long and hasn’t reported first-year results yet.
Sharp’s performance was right in line with the average performance of the 32 pioneer accountable organizations nationwide, according to a report Medicare released in July.
That report said that spending on the 669,000 beneficiaries assigned to the organizations rose 0.3 percent, less than the 0.8 percent growth rate observed for similar Medicare fee-for-service patients.
Thirteen of the 32, Medicare said, saw spending decreases enough to share in gross savings of $87.6 million. Only two of the participants lost money, a total of $4 million. All of the organizations, Medicare said, met quality guidelines designed to keep organizations from saving money at the expense of patients’ health.
Today the number of participating organizations has shrunk to 23, with nine of the original 32 dropping out or moving to a less potentially risky type of accountable care organization.


Lawton R. Burns, director of the Wharton Center for Health Management and Economics at the University of Pennsylvania, said the jury is still out on whether the accountable care experiment will work over the long run.
He noted that the largest and most sophisticated health systems are participating in the pioneer program, and said the true test will be whether the financial model creates efficiencies that change the way services are provided to all Medicare beneficiaries.
“What we would tend to look for is, did they start practicing differently in the larger body of fee-for-service (Medicare) patients?” Burns said.
Fleury said there already has been some spillover at Sharp. She said Sharp has implemented the 33 quality measures required of accountable care organizations for all of the Medicare patients it sees. As a result, she said, all seniors are now getting fall assessments and depression screenings, for example, that they were not getting before.
Sharp has had to pay for these improvements out of its own reserves.
While Sharp did break even in its first year of program participation, Fleury said the region’s largest health system has invested nearly $2 million hiring additional care coordinators and other professionals necessary to shrink spending. So, at the end of the first year, Sharp’s accountable care organization is technically in the hole.


Why then, would Sharp decide to hang in there for a second year?
Fleury said this year’s performance is looking better than last year’s, and there are other benefits, she said, that don’t necessarily show up in the profit-and-loss statement.
“As a board, we discussed the cost-benefit of the program. We have a patient advocate on our board who believes very strongly that this is the right thing for the patients,” Fleury said.
She said those extra care coordinators that Sharp has hired are spending time focusing on the 5 percent of Medicare patients whose medical needs are complex. This may mean a regular home visit, for example, to help a patient decipher the dosing schedule for a slew of medications.
“We’ve found that patients are really enjoying it,” Fleury said.
And, she added, continuing with the program allows Sharp to participate in Medicare’s grand experiment to change the way reimbursement is doled out nationwide.
Exiting now, the executive said, would mute Sharp’s voice in helping shape what could end up being national policy.
“By walking away, you really walk away from helping CMS design a model that is sustainable,” Fleury said.
While it did not walk away, Sharp did decide to reduce the amount of skin it’s exposing in the ACO experiment.
Initially, Sharp could have won or lost up to $37 million based on its yearly performance. Fleury said the company has selected a different variant of the program that shrinks that number to $17 million.