Many physicians say they lack specific details about the care model and how it will reimburse providers

In its own news service, the American Medical Association (AMA) reports lagging interest by physicians when they are asked about their participation in accountable care organizations (ACO). This survey of AMA members was conducted last fall.

According to an article at amednews.com (AMN), this survey found that—although many physicians are familiar with the concept—a significant number of them indicate they will either opt out of an ACO or unsure whether they will participate in an ACO.

 “ACOs are like unicorns,” stated Nancy Greenstreet, M.D., a family physician and Medical Director of Physicians Medical Group of Santa Cruz County in California. “Everybody wants one, but nobody knows what it is yet.”

As most pathologists and clinical laboratory managers know, Medicare officials have high hopes that accountable care organizations can help providers deliver a higher quality of patient care, while better managing the overall cost of that care. By design, ACOs tie provider reimbursement to achieving specific patient outcome goals and reductions in the total cost of care for an assigned population of patients.

Accountable Care Organizations are expected to bring significant changes. Yet, as determined in a recent study of 1,000 physicians conducted by the American Medical Association, a significant number physicians are still unsure about whether they will participate in an ACO. (image by http://blog.riskmanagers.us.)

Accountable Care Organizations are expected to bring significant changes. Yet, as determined in a recent study of 1,000 physicians conducted by the American Medical Association, a significant number physicians are still unsure about whether they will participate in an ACO. (image by http://blog.riskmanagers.us.)

“A well-developed ACO model has the potential to improve care coordination and quality while promoting cost savings,” wrote AMA President Cecil B. Wilson, M.D., in a statement that accompanied his organization’s letter to the Centers for Medicare & Medicaid Services  (CMS) to comment on proposed ACO rules, AMN reported.

According to industry insiders, lack of clarity about ACO details may be a major reason why physicians are uncertain about their participation in an ACO.

“Early-term” Survey Finds Doctors Want More Details on ACOs

The survey was conducted by Optum Institute for Sustainable Health, an arm of UnitedHealth Group (NYSE: UNH). It showed the following interesting data:

  • Of the 1,000 physicians polled, 61% were acquainted with the concept of the ACO payment model. Among specialists, the number was 59%. Among primary care physicians, the number was 64%.
  • Of those physicians familiar with the concept, 28% responded that they are considering forming or joining an ACO. For specialists, 23% were interested. At least 36% of primary care doctors are considering the move.
  • Of the 1,000 physicians canvassed, 26% are not considering participating in an ACO. Among specialists and primary care doctors, the naysayers numbered 31% and 18%, respectively.
  • Of physicians familiar with the ACO model, 46% responded they did not know whether their practice would join or form an ACO. Specialists and primary care physicians responded with similar numbers.

In its reporting, AMN acknowledged that the survey findings of physician uncertainty is partially because the survey was conducted during the first 10 days after the CMS released its final rule governing Medicare ACOs.

According to analysts, another cause for the uncertainty is the fact that the ACO model has been used for several years. AMN noted the concept has been around for several years, but ACOs are gaining attention now because it is included in federal health care reform, insurance.com noted in an article on ACOs.

This lingering uncertainty among physicians includes concerns over the following issues:

  • How will patient outliers affect the ACO program?
  • Who will run the ACO?
  • What type of ACO will the entity be (CMS has two ACO tracks)?
  • How will practices be judged and how will savings be achieved?
  • Will the ACO contract only with Medicare or with commercial insurers as well?
  • How will shared savings be divided among participants?
  • How will reducing total cost of care received by a patient affect fee-for-service revenue?
  • Will any loss be balanced out by shared savings bonuses?

Clear Up Confusion

Various organizations are seeking to help clear up physician confusion around ACOs. “The AMA is committed to assisting physicians engaged in the formation of ACOs and participation in other payment models,” declared Jeremy A. Lazarus, M.D., AMA President-elect, during an AMA-hosted webinar, AMN reported.

The National Committee for Quality Assurance (NCQA) launched an accreditation program for ACOs in hopes of making things clearer. (See Dark Daily, “Clinical Pathology Labs Take Note! Six ACO Early Adopters Seek Accreditation from NCQA,” Januiary 24, 2012.)

Analysts advise physicians not to rush to join an ACO. Instead, they recommend that physician practices study new payment models and seek the model that best fits, whether it’s an ACO, bundled payment, medical home, or some other program.

“In large part, it’s going to be a business decision that takes in a variety of factors,” noted Anne W. Hance, J.D., a partner at McDermott Will & Emery law firm in Washington, D.C. Hance advises health industry stakeholders on federal and state regulatory matters.

Another healthcare attorney agreed that waiting was a good strategy. “This is more of a coming trend than something [physicians] need to participate in right away, but they ought to be thinking about these things,”  Fred Geilfuss, J.D., a partner in the health law practice of Foley & Lardner in Milwaukee, told AMN.

As Dark Daily observed in its October 2011 coverage of the impact of ACOs on laboratory medicine, clinical laboratory managers and pathologists will want to stay ahead of this important trend. (See Dark Daily, “Accountable Care Organizations [ACOs] Expected to Encourage Appropriate Use of Clinical Pathology Laboratory Test”.)

Pathologists and medical laboratory managers should also keep in mind that, effective January 1, 2012, the Centers for Medicare and Medicaid Services has begun to contract with ACOs. It has identified 32 ACO organizations which it is calling “Pioneer ACOs.” These forward steps mean that the drive toward tighter integration of clinical care with the American healthcare system has begun.

—Pamela Scherer McLeod

Related Information:

Physicians uncertain about taking part in ACOs

What is an accountable care organization and why should you care?

“Accountable Care Organizations (ACOs) Expected to Encourage Appropriate Use of Clinical Pathology Laboratory Test”

Clinical Pathology Labs Take Note! Six ACO Early Adopters Seek Accreditation from NCQA

THE DARK REPORT: Healthcare Reform and Laboratory Testing

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