“Is this a new organization trying to do new things to deliver the right care at the right time? Or is it something old in new clothing?”
A
COs may be a new attempt to solve an old problem. But that void, says Dr. Carter, gives physicians an opportunity to take the lead as the model takes off in Texas and across the country.
“Most of the focus thus far has been on the cost side,” said Dr. Carter, medical director for care co- ordination and quality improvement for Kelsey-Sey- bold. “But physicians have the most direct influence over the utilization, cost, and quality of care,” which he says puts doc- tors in the driver’s seat. Texas has more than two dozen ACOs, according to a Febru-
ary analysis by the health care consulting firm Leavitt Partners. And the latest federal figures show more physicians lead
Medicare ACOs than do hospitals. The last round of ACO approvals by the Centers for Medicare & Medicaid Services (CMS) earlier this year bumped the number of physician-led groups to 202, compared with 189 for hospital-led organiza- tions. That’s a reversal from a year ago, when hospitals headed up 91 ACOs, compared with 45 led by physicians. Physician interest is growing, too: Medscape’s 2013 Physi- cian Compensation Report showed 24 percent of the nation’s physicians are ei- ther in an ACO or plan to join one. In Texas, 22 percent of physicians say they are discussing or considering joining other health care providers to form an ACO, according to the Texas Medical
20 TEXAS MEDICINE July 2013 Gregory S. Sheff, MD Seth Kaplan, MD
Association’s 2012 Physician Survey. Of those, 72 percent are discussing the move with other doctors. Physician leaders acknowledge that the models take a fair
amount of infrastructure and adaptation to work, and an ACO may not suit every doctor or community. Still, the Patient Protection and Affordable Care Act’s focus
on accountable care appears to be making an impact, at least in the short term. That, coupled with employers’ and govern- ment and private health plans’ appetite for value-based care, could mean more of these models will move into the neighbor- hood with a role for physicians to play. On the one hand, physicians can look at an ACO as one way
of reorganizing to meet market demands for value-based care, TMA Vice President for Medical Economics Lee Spangler, JD, told physicians at an ACO symposium hosted by TMA and the Travis County Medical Society in February to help physicians navigate the evolving health care environment. On the other hand, he warns, with no regulation on use of the term “ACO,” physicians considering the move also must carefully evaluate, “Is this a new organization trying to do new things to deliver the right care at the right time? Or is it something old in new clothing?”
TMA does not endorse participation in an ACO or any other
postreform program. The association encourages physicians to be wary, to be informed, and to take the time to learn about these systems, understand their differences, and consider what they can mean to their practice and their patients.
Tools for innovation While there is no guarantee the ACO experiment won’t amount to a managed care redux, physician leaders highlight some distinctions from the 1990s phenomenon.
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