Accountable Care Organization

“The GW Medical Faculty Associates aims to deliver a value of care, to improve quality of care through cooperation and coordination among physicians for our Medicare Fee-For-Service patients in the Washington Metropolitan Area.” 

GWMFA is now participating in the CMS Medicare Shared Savings Program Accountable Care Organization (ACO), which is designed to provide high level of access and coordination of care that is needed to better care for our Medicare Fee-For-Service beneficiaries by:

  • Promoting accountability for the care of Medicare fee for service beneficiaries.
  • Requiring coordinated care for all services provided under Medicare fee for service.
  • Encouraging investment in infrastructure and redesigned care processes.

My (Doctor’s) office sent me a letter, what do I need to do?
You do not need to take any additional steps to continue to receive care from your usual healthcare team. You are still enrolled in Medicare, and you have the right to use any doctor or hospital that accepts Medicare, at any time.

I received a letter that my Doctor is participating in an ACO. What are the forms included in this letter? Do I have to fill them out?
It’s important to know that your Doctor, not you, is participating in an Accountable Care Organization (ACO). You don’t have to fill out any forms or take any action to keep seeing him or her.

The letter you received should include a form “Declining to Share Personal Health Information.” In order to provide you better care, Medicare would like to share information about your visits with other doctors, hospitals, and pharmacies. This information can help your Doctor and other healthcare providers give you the best possible care.

You can choose to prevent Medicare from sharing this information by calling 1-800 Medicare; or completing the form attached with the letter and returning it to your Doctor’s office. You should fill this form out ONLY if you don’t want Medicare to share information.



What is an ACO?

An Accountable Care Organization (ACO) is a group of doctors and other health care providers who voluntarily agree to work together with Medicare to give you high quality service and care at the right time in the right setting.

Your doctor chose to participate in a Medicare Shared Savings Program ACO because he or she is committed to your care experience. Your provider will work closely with other doctors and health care providers in the ACO to coordinate your care.  They may also be rewarded for providing you with high quality and more coordinated care.

The goal of the ACO is to support your doctor in caring for you.  ACOs help your doctor and healthcare providers work together more closely, by making sure they have the most up-to-date information about your health and your care.  This facilitates improved communication among physicians about your care. For you, it eliminates duplicate tests or redundancies in care.  Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.

An ACO isn’t the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO).  You are still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change.  And you still have the right to see any doctor or hospital that accepts Medicare at any time, the same way you do now. 

General Questions

For general questions or additional information about Accountable Care Organizations:
Call 1-800-MEDICARE (1-800-633-4227) (TTY users should call 1-877-486-2048 or
Visit www.medicare.gov/acos.html
Call GWUMFA 202-741-3020

 



Frequently Asked Questions:

How do I know if my Doctor is in an ACO?
ACOs must provide in-office notification of the provider’s participation in the ACO in settings in which the beneficiary receives primary care services.  In addition to this, GWMFA has mailed information to those patients whose doctors and/or other healthcare providers are participating in the ACO.

If I have not been notified that my doctor is in an ACO, what do I need to do?
You don’t need to do anything. Your doctor decided to participate in an Accountable Care Organization (ACO). Even though your Doctor is participating in an ACO, your Medicare benefits won’t change. You’ll still be in Original Medicare, and you’ll still have the right to use any doctor or hospital that accepts Medicare, at any time. 

Do I have to participate in an ACO since my Doctor is?

ACO participation is for medical providers only. If your doctor is in an ACO and you do not wish to allow CMS to share your information with other participating entities within the ACO, you can decline to have CMS share your information by signing a non-disclosure form.

You will continue to have the right to see any doctor or hospital that accepts Medicare, at any time.

You can continue getting care from your Doctor, or you can choose to see a Doctor who doesn’t participate in an ACO.  It is your choice. 

Can I still see all of my regular Medicare doctors and healthcare providers?
It’s important to know that:

  • You are still in Original Medicare.
  • You are still entitled to all the same Medicare services, benefits, and protections.
  • You can still go to any doctor, hospital, or other provider that accepts Medicare.

Can I still choose to receive services from any new doctor, hospital or healthcare provider that I want to?
You can still choose to go to any doctor, hospital, or other healthcare provider that accepts Medicare. No one – not even your current Doctor - can prevent you from seeing the doctors, hospitals or providers you want. 

What information about me will the ACO have access to?
To help doctors who participate in an ACO give patients like you the best possible care, Medicare wants to share some additional information about your care with them. This information includes but not limited to doctor’s visits, hospitalizations, and pharmacy visits in the past and moving forward. This information helps your Doctor and other ACO providers, track the services you’ve already received and coordinate a care plan. If you decide you do not want to have the information about your care shared with the ACO, you can do so by filling out the disclosure form.

How can I decline to have my personal health information shared?
We value your privacy, so it’s important to know that you can prevent Medicare from sharing this information at any time.

There are three ways that you can prevent your information from being shared:

  • You can call 1-800 MEDICARE (1-800-663-4227). TTY users should call 1-877-486- 2048 and tell the operator you are calling about ACOs.
  • You can complete and sign the “Declining to Share Personal Health Information” form in your doctor’s office.
  • We can send you a form to sign and return.

Also, Medicare will not share any information about alcohol and drug treatment history, if you have received such treatment, unless you choose in writing to share it.

After your form or phone call is received, Medicare will update its records to show that you do not want to have your data shared. If you call 1- 800 Medicare, you will receive a letter confirming this change. It will take about 45 days for this change to take effect.

What if I change my mind and decide that I do want my personal health information shared in the future?
If you change your mind in the future, you may call our office and we will send you a form, called a “Consent to Change Personal Health Information Preference” form that you can complete and mail back to your Doctor’s office. Or you can call 1-800 Medicare (1-800-663-4227) and tell them that you have changed your mind and that you do want your data shared. You will receive a letter confirming this change.

What if I received alcohol and drug treatment, will that information be shared with the ACO?
To help you get the best possible care, Medicare shares general health information with the participating providers in ACO, including your Doctor.  However, to protect your privacy, Medicare doesn’t share any information about treatment a patient received for alcohol and drug treatment (also known as substance abuse) with a participating ACO unless the patient chooses in writing to share it.

If you want Medicare to share information about any medical history relating to alcohol or drug treatment, you can do so by writing to Medicare.

What if I change my mind later and decide that I do not want information shared about drug and alcohol treatment?
You can change your mind at any time. All you need to do is call 1-800 Medicare and tell them that you no longer wish to have your drug and alcohol treatment information shared. You will receive a letter confirming the change and it will take about 45 days to take effect.

How long do I have to respond to say that I do not want my personal health information shared with the ACO?
Medicare values your privacy. For that reason, you can prevent Medicare from sharing your personal health information, or otherwise change any of your preferences, at any time.

Just call 1-800 MEDICARE, and they can help you set your preferences the way you want them. You can also return the “Declining to Share Personal Health Information Form” to your Doctor’s office. 

I recently enrolled in a Medicare Advantage Plan but I also received a notice that my Doctor is part of an ACO, does that change anything?
Because you chose to enroll in a Medicare Advantage Plan, the notice you received about Accountable Care Organizations (ACOs) is no longer accurate. Please disregard it.

What if I am already happy with my care the way it is?
We’re glad you’re having a positive experience already. You can continue to see your Doctor the way you have been. Your Doctor’s participation in an ACO won’t change your benefits in any way, and decisions about your care stay with you and your Doctor.

How will being in an ACO help my doctor?
Doctors in ACOs may have better access to the expertise, staff, and technology they need to make sure your care is coordinated across all the places you get services. For you, this coordination could mean less paperwork to fill out at the doctor’s office, avoiding unnecessary tests, or more help for you in dealing with any health conditions. 

Can I receive a written translation of the letter from my doctor?
1-800 Medicare cannot provide you with a written version of the letter at this time. Please know that you can always call 1-800 Medicare to get the information verbally, over the phone.

My relative received a letter from the ACO, but they passed away recently, what do I need to do?
We are sorry to hear about your loss. These letters were sent because of your relative’s history of receiving care from their Doctor who is participating in the ACO.  You don’t need to do anything further – over time your relative will be removed from the list of patients affiliated with the participating Doctor.