The American Medical Association has released a guide for physicians on accountable care organizations, covering the model's legal and governance issues. The guide covers the numerous points on physicians' role in ACOs. It also outlines the possible avenues physicians can take in regards to ACOs, which are listed below.
1. Don't do anything. The guide mentions that physicians in "unique situations," such as those specializing in in vitro fertilization, may be able to continue to practice as usual since they are in a unique market driven by patient choice.
2. Continue present course but attempt to grow practice. A smaller group of physicians can attempt to grow by merging groups or adding more physicians. This will help the group better negotiate payor rates and document quality.
3. Seek hospital employment. This can eliminate substantial administrative duties and provide infrastructure.
4. Form large clinically integrated practice associations that can negotiate as one. Large clinically integrated systems may be able to provide physicians to ACOs or hospital systems.
5. Changing to concierge or direct practice. The AMA says this method of practice will likely remain viable after the insurance reform provisions of PPACA take effect.
6. Partner with a hospital. Physician groups can retain some independence but receive compensation from hospitals for providing management services of a specific service line.
7. Partnering with health insurers. The AMA says physicians may want to consider this route to obtain the capital and necessary data for ACO operation. Still, the success of this scenario will depend on the willingness of the payor to "cede significant control to the physician group," according to the guide.
8. Insurance CO-OPs may be a possibility. PPACA authorizes the creation of insurance CO-OPs that might compete in providing insurance through HIEs that PPACA mandates by Jan. 2014. By developing a CO-OP, physicians may have greater control of the payor with which they would affiliate.
Read the full-length AMA guide on ACOs (pdf).
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1. Don't do anything. The guide mentions that physicians in "unique situations," such as those specializing in in vitro fertilization, may be able to continue to practice as usual since they are in a unique market driven by patient choice.
2. Continue present course but attempt to grow practice. A smaller group of physicians can attempt to grow by merging groups or adding more physicians. This will help the group better negotiate payor rates and document quality.
3. Seek hospital employment. This can eliminate substantial administrative duties and provide infrastructure.
4. Form large clinically integrated practice associations that can negotiate as one. Large clinically integrated systems may be able to provide physicians to ACOs or hospital systems.
5. Changing to concierge or direct practice. The AMA says this method of practice will likely remain viable after the insurance reform provisions of PPACA take effect.
6. Partner with a hospital. Physician groups can retain some independence but receive compensation from hospitals for providing management services of a specific service line.
7. Partnering with health insurers. The AMA says physicians may want to consider this route to obtain the capital and necessary data for ACO operation. Still, the success of this scenario will depend on the willingness of the payor to "cede significant control to the physician group," according to the guide.
8. Insurance CO-OPs may be a possibility. PPACA authorizes the creation of insurance CO-OPs that might compete in providing insurance through HIEs that PPACA mandates by Jan. 2014. By developing a CO-OP, physicians may have greater control of the payor with which they would affiliate.
Read the full-length AMA guide on ACOs (pdf).
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9 Transactions Between Hospitals and Physician Groups