The St. Louis Physician Alliance (SLPA) welcomes your questions regarding our clinically integrated network. We’ve put together a list of the most commonly asked questions thus far.
Who governs SLPA?
SLPA is governed by a 13-member Board of Managers, including 11 practicing physicians elected by the membership who serve 2-year terms, an appointed USPI executive, and an appointed community representative. The SLPA Board chairman is a practicing physician elected by the other Board Members. Since the terms of the physician board seats are staggered, an election for new physician board members will be held annually.
Is SLPA an Accountable Care Organization (ACO) working with Medicare?
In the summer of 2014, the SLPA Board of Managers approved the formation of a separate legal entity called SLPA ACO, LLC to apply for the Medicare Shared Savings Program (MSSP). SLPA ACO, LLC submitted an application to the Centers for Medicare and Medicaid Services (CMS) for this program which allows Medicare to work with eligible Accountable Care Organizations (ACO) which are health care providers (ie--primary care physicians, specialists, and hospitals) working together collaboratively to accept collective accountability for the quality and cost of care delivered to a defined patient population. SLPA ACO, LLC was awarded a three-year Medicare agreement with CMS for the MSSP effective January 1, 2015. SLPA intends to continue with the work of developing a clinically integrated network of providers who are committed to the goals of higher quality and lower overall cost of care, through effective clinical integration.
Can any physician become a participant of SLPA?
The membership is open at this time to any board-certified or board-eligible physician wishing to be joined with the network and its clinical partners in an alliance focused on improving quality, reducing costs, and clinically integrating the care of our patients. All new applicants for membership are presented to the Board of Managers for final approval. Physician participation in SLPA committees is highly encouraged. To become a participant in SLPA ACO, a separate agreement needs to be executed and the participant needs to be approved by CMS.
Is there a fee to participate in SLPA?
Yes, there is a one-time participation fee of $300 that is required for each physician. Facility (non-physician) providers pay a one-time $500 participation fee per tax ID. There is currently no additional participation fee for SLPA ACO, LLC.
Who are the owners?
SLPA is a for profit organization with USPI as the owner. SLPA ACO, LLC is a separate legal entity so a participation agreement is required to be a part of that organization.
I am a specialist. What are some of the advantages to joining SLPA?
The value added benefits of joining SLPA include participation in creating and excelling in the clinical integration world of tomorrow. By dedicating yourself to a common mission, with like-minded providers, dedicated to the goals of improved quality and reduced cost through effective clinical integration, SLPA membership will create a firmly linked position in a care network.
I am a primary care physician. What are some of the advantages to joining SLPA?
Most health care reform proposals strongly encourage all patients to have a medical home. SLPA will assist primary care physicians in becoming Patient-Centered Medical Homes recognized by the National Committee for Quality Assurance (NCQA) which is an independent, non-profit organization focused on improving the quality of health care by using the administration of evidence-based standards, measures, programs, and accreditation. Having this designation can improve rewards and attract patients. Other practice management resources can be available as well to assist practices in today’s difficult business environment.
Are there potential financial rewards to clinical integration?
Given the current and projected health care spending constraints, there will likely be no rewards to physicians and hospitals that do not commit themselves to improving quality while reducing costs through effective clinical integration. In fact, reductions in revenues are clearly on the horizon for both doctors and hospitals. However, most payers appear willing to reward cost effectiveness if accompanied by high quality and good patient satisfaction.
What are the benefits of joining? The elevator speech that I can tell my partners/colleagues?
How do you bring new technology into this equation?
There will have to be a place for innovation in the health care of the future since the system cannot support going backward in advancing best care. SLPA will have a voice in developing the cost/benefit to our participants as well as how to appropriately distribute reimbursement, relative to bundled payments.
How do you project the Shared Savings curve? Growth? For how long?
Intuitively, we expect that as the costs are reduced and shared savings are gained, a plateau will be reached. How savings will grow and for how long is still to be projected. Some say that the health care system will move to a bundled payment and/or capitation model in the future.
Are there incentives/disincentives to keep patients within the SLPA network?
We believe that a participating provider will want to keep patients within the SLPA network to assure quality and manage the costs for patient care. We also believe that health benefit insurance plans supported by the SLPA employer and payer contracts will incentivize the patients to stay within the SLPA network and further encourage their physicians to look for services within the network. We believe through clinical integration, that SLPA primary care and specialty participating providers will want to remain within the care stream via the health information exchange to improve access to patients within their practice.
Will my performance be measured by the percentage of my patients that stay within the network?
There are a number of options being considered for performance measures. Under consideration are the 33 Core Measures required by the Medicare Shared Savings Program. Also, a study is underway of other similar clinically integrated organizations on performance measures. In some cases, it may make sense to measure a physician’s performance based on network utilization but that is not clear at this time. Any such measure, provided it is consistent with applicable law, would need approval by the appropriate SLPA Committee(s) and the SLPA Board.
How do you address group practices when all providers are not part of SLPA; i.e. performance measures, care paths?
Currently the panel is open but all providers within a group are not required to be a part of SLPA. The group itself may sign a group participation agreement or each individual physician from the group who chooses to participate can sign an individual participation agreement.
What data is being monitored? What type of quality data will be collected and reported? Inpatient and Outpatient?
The SLPA Quality Committee and Technology Committee have been studying which data will be available to SLPA participants and how the data will be able to be accessed, congregated, and reported. The Physician Quality Reporting System (PQRS), a pay-for-reporting program that gives eligible professionals incentives and payment adjustments if they report quality measures satisfactorily serves as a basis for quality metrics as well as the 33 ACO quality metrics specific to the Medicare Shared Savings Program.
How do you address ancillary (lab, imaging, etc) “self utilization”? Will ancillary services also be “credentialed” to be part of SLPA?
Physician participating providers and ancillary services will be credentialed separately. Each scenario for self-utilization and ancillary credentialing will be considered on a case-by-case basis. Criteria will be established by the Credentialing Committee for credentialing, and certain criteria such as quality, best care practices, as well as cost savings will be considered.
How will SLPA support care coordination? What are the care coordination requirements for the participant physician offices?
SLPA will study the care coordination needs through our Quality Committee. There are some best care examples in the community that have shown some successful results, allowing health care practitioners to work at the top of their licenses. The other important questions for care coordination are what is the best utilization of resources available and where is the best place for the care coordination to reside. More information will be coming to the participants as we progress.
How will the facilities reconcile the idea that utilization may be reduced, and specialty volumes may be reduced?
We recognize the current health care crisis of rising costs, and duplication/waste. Hospitals and physicians understand that improved quality of care produces less utilization, in some specialties this has already occurred. We have some options to reduce significantly fixed costs through clinical integration.
How do we manage participating providers who do not follow care paths and best care protocols?
All participating providers will expressly agree to follow best care practices and care paths. If some do not, the results will be determined by their peers on the various committees and the Board. Following attempts at education, non-compliant participants may be asked to leave the organization based on results of performance measurements of quality, cost, and best care practices.
Why have open panels for the network? Why not hand-pick physicians and certain specialties?
The idea is to be inclusive, with broad primary care and specialty panels. The SLPA Board and various committees will monitor enrollment and recognize that at a point in time in the future the panel may be closed.
What is in it for the patient? How do we incentivize patients?
Improved clinical integration will have a natural outgrowth of clearer navigation for services for the patient. We are already beginning to see health plans directing patients and encouraging in-network care by means for financial incentives like copayments and payments for participation in exercise and/or prevention programs.
If your question is not covered on the list, please email us: email@example.com
Keep in mind that the most important questions regarding the St Louis Physician Alliance are:
With low barriers to enter and to exit our network, there is nothing to lose by joining so become a participating provider today.