Pioneer ACO notification letters mislead patients, anger docs

Recent letters notifying patients about accountable care organization (ACO) changes are misleading patients into thinking their providers agreed to the federal program when some haven't, physicians in Southern California say.

Heritage California ACO, an affiliate of Heritage Provider Network, is one of the 32 Centers for Medicare & Medicaid Services-recognized Pioneer ACOs. In a letter to patients, Heritage California ACO explained to patients (some of which have no connection to Heritage) about the new federal health program and told them unless they opt out, they are part of the program and therefore their medical information is subject to sharing, the Ventura County Star reported.

However, ACO notification letters should go out only to patients of providers who agree to participate in the ACO, according to CMS.

The letter informed patients, "your doctor is participating in a Medicare Accountable Care Organization," but that wasn't true in all cases, the article noted. For instance, Harris Wasser, a Simi Valley internist and endocrinologist, is not a Heritage physician but does business with the network when he sometimes sees patients in the hospital.

The confusion among patients at Heritage California ACO is similar to the recent situation at Partners HealthCare, which includes Massachusetts General and Brigham and Women's hospitals, when last month it fielded calls from confused senior patients who received letters about the Pioneer ACO changes. Some patients had little understanding of what an ACO even is and therefore had questions about their option to opt out.

Jonathan Gluck, senior executive with Heritage Provider Network, said much of the letter's language came from CMS officials, whose decision it was for patients to enroll in the program (by default) unless they opt out.

For more information:
- read the Ventura County Star article
- see an ACO explanation letter from Partners
- check out the CMS FAQ sheet for patients (.pdf)

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