The St. Louis Physician Alliance (SLPA) welcomes your questions regarding our clinically integrated network. Below is a list of the most commonly asked questions.
Who governs SLPA?
SLPA is governed by a 16-member Board of Managers, including 13 practicing physicians (6 of whom are elected by the membership for 2-year terms), two appointed USPI executives, and an appointed community representative. The SLPA Board chairman is a practicing physician elected by the Board Members. Since the terms of the physician board seats are staggered, an election for new physician board members is held annually each fall.
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, 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 the 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 its intial three-year Medicare agreement with CMS for the MSSP effective January 1, 2015. SLPA ACO entered its second three-year contract effective January 1, 2018. SLPA continues 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 collaboration, increased communication and data analysis.
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. To become a participant in SLPA ACO, a separate agreement needs to be executed along with other required documents during the annual CMS enrollment window. The applicant will be reviewed by the SLPA physician committees and Board before being submitted to CMS for final approval. Physician participation on SLPA committees is highly encouraged.
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?
The St. Louis Physician Alliance is a for profit organization with USPI as the owner. SLPA ACO, LLC is a separate legal entity owned by St. Louis Physician Alliance. Tenet Healthcare is the owner of USPI.
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?
Collaborating with like-minded independent physicians and coordinating care among patients is one of the advantages to joining the St. Louis Physician Alliance. As a member, you’ll have access to group purchasing organizations (GPOs), discounted medical liability insurance, marketing through the SLPA website directory and physician spotlight feature, networking events, webinars and other educational opportunities.
Are there potential financial rewards to clinical integration?
In addition to the reduction of the MIPS reporting burden, participation in SLPA ACO can provide potential financial rewards through MSSP shared savings. For performance year 2016, SLPA ACO saved $13 million in costs and received a $5.8 gainshare payment from CMS which was shared with ACO physicians.
What are the benefits of joining? The elevator speech that I can tell my partners/colleagues?
- Participation with a clinically integrated organization that shares information via a population health platform for contracts that offer shared savings, bundled payment, and/or other new payment methods;
- Participation in development of clinical best practice integration and evidence-based care paths; and
- Being identified with a brand supporting quality, reducing waste, and decreasing health care costs.
How do you bring new technology into this equation?
SLPA works with various population health platforms and practice EHRs to manage our ACO population and report the ACO quality measures on an annual basis.
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?
The SLPA Finance Committee developed the (Board approved) physician MSSP gainshare formula and methodology which defines how performance is rewarded within the ACO. Quality performance plays a key role in the methodology.
What data is being monitored? What type of quality data will be collected and reported? Inpatient and Outpatient?
CMS requires ACOs to report on a standard set of pre-determined ACO quality measures annually. These include CAHPS measures, claims-based measures, a double-weighted EHR usage (Promoting Interoperability) measure and point-of-care documented measures. SLPA ACO works very closely with our PCP practices to ensure that the point-of-care documented measures are understood and collected for annual reporting purposes.
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 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. Care coordination is a key component of a successful ACO.
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 reviewed by their peers on the various committees and the Board. Following attempts at education or other performance improvement initiatives, 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.
If your question is not covered on the list, please email us at email@example.com
With low barriers to enter and to exit our network, there is nothing to lose by joining so become a participating provider today.