whether through a hospital affiliation or physician group prac- tice. But they likely will have to practice in larger groups, Dr. Carter says. From influencing ACO governance and payment distribution, to holding physicians accountable, there is much to be gained from physicians organizing with strong leader- ship.


If there are multiple competing hospital systems in the re-


gion, a formal partnership may not be necessary. But physi- cian groups may want to consider some sort of collaboration if there is a single hospital system, he says. Geography is another factor. Because ACOs require a cer- tain critical mass in terms of size, scope, and money, the model may better fit an urban setting than a rural one. To improve access to capital for smaller rural or physician-


owned ACOs, the federal health reform law created a Medicare Advanced Payment model. It provides up-front payments to help groups get started and invest in things such as staff, elec-


tronic data systems, and other necessary infrastructure. That money is recouped from any future savings earned. In Texas, the 2011 Legislature authorized more scalable health care collaboratives, which also could give smaller prac- tices an easier path to integrated care and alleviate some of the antitrust concerns that could arise when individual physi- cians collaborate. (See “ACOs, Texas-Style,” June 2013 Texas Medicine, pages 25–28.)


Whatever path physicians chart, it likely will require change, which is why Dr. Carter issues this warning: “If you are think- ing about joining an ACO, and the hospital or whoever is doing it says you can keep practicing the same way you are, I would be skeptical of that.” n


Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by tele- phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at amy.sorrel@texmed.org.


TMA LAUNCHES PHYSICIAN SERVICES ORGANIZATION FOR PATIENT CARE


As health care delivery and financing shift toward value-based accountable care models, TMA offers brand new tools to help all types of physician prac- tices adapt to meet those market demands and pro- vide more efficient patient care while preserving the patient-physician relationship. From building practice infrastructure, to improv- ing clinical and cost performance, to pursuing clinical integration, TMA’s Physician Services Organization for Patient Care will offer services that bolster physicians’ clinical and financial autonomy, whatever the prac- tice’s current level of sophistication may be. A key element will be providing physicians easy


access to data to measure and improve their clinical performance and financial viability. For example, one service might help physicians


comb through their data to identify chronically ill patients who need extra help to stay as healthy as possible and stay out of the hospital. Another might align primary care physicians and specialists to better


coordinate the care they provide to their common patients. “The market is shifting rapidly. Physicians are under


tremendous pressure to change what they’ve been doing. But no one is helping them do that. This is a very high priority,” said TMA President Stephen L. Brotherton, MD. He added that he is confident the Physician Ser-


vices Organization for Patient Care “will save local practices. Texas doctors are determined to make health care better and more affordable for Texans. To do that, we need to shift the balance of power away from the government and the large hospital systems and back to the patients and their physicians.” Besides TMA, the Dallas County Medical Soci- ety (DCMS) and the Harris County Medical Society (HCMS) are key members of the organization. It will bring in new and existing physician groups, health plans, and technology vendors as needed to test and develop effective new care models.


July 2013 TEXAS MEDICINE 25


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