Mitigating the downside of ACOs

Thomas Doerr, MDThomas Doerr, MD

As the healthcare landscape continues to evolve, accountable care organizations are becoming progressively more popular among physicians searching for new, cost-efficient ways to deliver their services.

According to Medscape’s 2014 Physician Compensation Report, 34 percent of the 24,000 physicians surveyed claimed to already be a part of an ACO or were planning to join one this year. And considering ethical guidelines that encourage physicians to practice effective and efficient healthcare while using resources responsibly, the trend toward accountable care makes even more sense, especially to physicians like Thomas Doerr, MD, an internist and director of innovation research for Lumeris.

[See also: Physicians' pay on the rise]

Of course, the decision to participate in an ACO doesn’t come without its risks. “One physician said it is like the difference between being a bus driver and being a jet airplane pilot: higher stakes and higher satisfaction,” Doerr explained.

That said, physicians don’t have to make the transition harder than it needs to be. Doerr detailed for Medical Practice Insider some of the top challenges posed by the ACO model and how interested providers can avoid them, and subsequently free themselves up to focus on the risks and satisfactions that count.

Q: What are some of the real-world steps practices should take to prepare for ACO participation?

A: Primary care providers, in particular, should create an educational handout that explains the patient’s and physician’s expectations and responsibilities in high-value healthcare. PCPs will be expanding the scope of their care to include performing many office procedures. PCPs should shift the routine follow-up of stable conditions (i.e., heart disease, diabetes, asthma, COPD and prostate problems) from specialists to their practices. Our organization has reduced the number of specialist visits by two-thirds while doubling the duration and number of PCP visits, compared to fee-for-service Medicare data. PCPs must also expand patients’ access to primary care; they should be available 24/7 for patient calls. Consequently, they must expand capacity through hiring physician extenders or delivering non face-to-face care.

Q: What are the risk factors physicians should keep in mind when considering the ACO option?

A: It usually takes a couple of years to make the transition from volume-based to value-based contracting. Physicians should get reinsurance for catastrophic illnesses and share the risk with colleagues in their office or with other PCP offices in a region. Some physician organizations also insulate PCPs from some of the actuarial risk when they have only a few members in the contract.

Q: What are some of the major ways practices can save with an ACO?

A: Practices in risk contracts can save money in several ways. First, they should try to get visibility into the unit costs for services from their payers. Second, some accountable PCPs attend monthly regional meetings in which they discuss which specialists do and don’t provide Triple-Aim-like care. They typically will invite selected specialists to their meetings to discuss approaches to providing that Triple-Aim-like care.

Q: What does the future hold for ACOs?

A: ACOs represent a state of transition from volume- to value-based care. In a given market, ACOs may emerge, persist for several years and then regress as they are displaced by contracts with greater risk sharing. One full implementation of value-based care is global risk contracting, which is gaining traction in states such as Minnesota and Massachusetts. It also is the most common model for Medicare Advantage plans.