“In all of these models we are talking about — accountable care organizations, medical homes, bundled payments — physicians are at the helm of the decisionmaking process with respect to patient care.”
he said, adding that it’s no wonder hos- pitals are on a buying spree of physician practices. Hospitals with their infrastruc- ture — buildings, equipment, technology — certainly have a role to play in prop- ping up accountable care models. “But we’re going to have very few successes in the long run if so many [accountable care entities] are hospital-driven.” Payers, too, have a significant role to
play, “but not as the lead,” Dr. Nackel said. They can be collaborative partners in driving value-based care through con- tracts that provide financial incentives to both physicians and hospitals. Payers also can capture and ware- house data on patients’ health and share that information with physicians and hospitals so that they can target complex, high-cost patients and identify preven- tive treatments. Payers’ downfall, on the other hand,
certainly the movement toward account- able or value-based care. So the pur- pose of the PSO is to develop solutions for physicians who want to participate in those innovative payment methods and retain some autonomy around their practice location and style,” Dr. McCoy said. “What we are talking about is em- powering physicians with the technology to take care of patients in the context where they are achieving higher value. TMA brings to the table not just that, but also the culture around providing the physician leadership, aggregation, and governance needed to empower the technology.”
Physician influence
Dan McCoy, MD
The timing for a PSO is just right, says Dr. Nackel. Health care reform in some form is here to stay, and of all the major play- ers — physicians, hospitals, and pay-
24 TEXAS MEDICINE January 2014
ers — physicians are most aligned with the goals of any collaborative model: improving quality, reducing costs, and improving patient satisfaction. Most of those savings and improve- ments come from a few key areas:
• Preventing inpatient admissions and readmissions;
• Reducing testing, surgeries, and other clinical procedures; and
• Cutting down on administrative costs.
The problem for hospitals develop- ing accountable care entities, Dr. Nackel says, is these objectives are typically at odds with their typical economic goals. Yet, most of the commercial and Medi- care ACOs today — more than 70 per- cent — are led by hospitals or health systems. “For a [hospital-driven] accountable
care model to work, the hospital has to reduce its own admissions. But it gen- erally has no revenue replacement. For everything they reduce, they actually reduce their revenue stream and profit- ability. So the ACO is destined to failure,”
is they are not on the front lines of pro- viding care. And the revolving door of patients — who typically drop or change their membership within three years be- cause of job or life changes — gives pay- ers little incentive to invest heavily in disease prevention. So when it comes to long-term popu- lation health management and individ- ual patient management — detecting and preventing disease, ordering treat- ments or hospital admissions, deciding discharge timing — physicians are the ones with the most direct influence on cost and quality and ultimately on the success of any value-based care model, Dr. Nackel says. Plus, physicians — pri- mary care, in particular — are in short supply but high demand in ACOs, medi- cal homes, and other value-based care models.
As they develop their future business strategies, physicians need to under- stand the influence their practices hold in the changing market, he added. “I can’t say what’s best for every individual physician. What I can say is, what’s best for the industry and long-term popula- tion health management is that physi- cians remain as physician groups, as op- posed to being owned by hospitals and payers, and that they focus on what they do well, which is patient care.”
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