There has been extensive deliberation over what accountable care organizations will look like and how various components of the healthcare system will fit within them. Here are five considerations for specialists regarding ACOs.
1. The role of specialists may be complicated due to a shortage of primary care physicians. A study on the primary care medical home model found the nation may not have enough primary care physicians to handle chronic disease care workloads, complicating the role of specialist physicians. The study, led by University of Michigan Health System, found specialists spend significant time — more than 650,000 work weeks collectively — on routine follow-up care for patients with common chronic conditions, including asthma, diabetes and lower back pain. The study proposed it may be more cost-effective if this care was delegated to primary care physicians, but that would require either thousands of them or an extra three weeks per year from those currently in the workforce.
2. Specialists will need to be careful in how they structure ACO agreements with insurers. A recent antitrust verdict against a New York-based specialty benefits management company, which could amount to almost $40 million, has served as a cautionary tale for specialists seeking a role in ACOs. Axel Bernabe, a partner in the New York office of Constantine Cannon, says Stand-Up MRI of the Bronx v. CareCore National, decided Nov. 30, demonstrates the potential dangers of specialists contracting with insurance companies to serve as exclusive gatekeepers for their networks by making the decision on which competing specialists are allowed to participate in those networks.
3. Specialists may present significant challenges to the geographic markets of ACOs. Physician collaboration is one of several points complicating ACO guidelines. Since there are fewer specialists than primary care physicians, specialists could easily manipulate the market if they align with only one ACO. Also, each separate market must be defined by each specialty, but there are disparities between them. Cardiac surgeons often compete in broader geographic markets than obstetricians, for instance.
4. Miscommunication between primary care physicians and specialists may be a barrier to the integrated care of ACOs. Perceptions on whether the information was transmitted differ between those who sent it and those who received it, according to a study by researchers at the Center for Studying Health System Change. While more than 69 percent of primary care physicians said they always or mostly sent the patient's history to the specialist, fewer than 35 percent of specialists reported they always or mostly received the information. And while 80 percent of specialists said they always or mostly sent consultation results to the referring PCP, but only 62 percent of PCPs said they received the information.
5. Specialists may be crucial to the reduction of readmissions and unnecessary care. The best way for hospitals to profit under ACO principles is by keeping people healthy, and hospitals need to have the efficiencies necessary to offer the best quality and results at a low cost. This requires hospital-physician relationships to become more cooperative. Hospitals need to put effort into their recruitment of specialists, who can assist primary care delivery by ensuring the right diagnosis the first time, says Timothy Hobbs, MD, CEO of Community Physicians of Indiana in Indianapolis. Dr. Hobbs, who oversees a physician group consisting of more than 200 physicians in more than 70 practices, says specialists help eliminate misdiagnosis and unnecessary care.
Read more about ACOs and physician integration:
- 7 Observations on the Queens County Medical Association's All-Physician ACO
- 10 Recently Launched ACOs
- 6 Ways for Community Hospitals to Align with Physicians in Competitive Markets
1. The role of specialists may be complicated due to a shortage of primary care physicians. A study on the primary care medical home model found the nation may not have enough primary care physicians to handle chronic disease care workloads, complicating the role of specialist physicians. The study, led by University of Michigan Health System, found specialists spend significant time — more than 650,000 work weeks collectively — on routine follow-up care for patients with common chronic conditions, including asthma, diabetes and lower back pain. The study proposed it may be more cost-effective if this care was delegated to primary care physicians, but that would require either thousands of them or an extra three weeks per year from those currently in the workforce.
2. Specialists will need to be careful in how they structure ACO agreements with insurers. A recent antitrust verdict against a New York-based specialty benefits management company, which could amount to almost $40 million, has served as a cautionary tale for specialists seeking a role in ACOs. Axel Bernabe, a partner in the New York office of Constantine Cannon, says Stand-Up MRI of the Bronx v. CareCore National, decided Nov. 30, demonstrates the potential dangers of specialists contracting with insurance companies to serve as exclusive gatekeepers for their networks by making the decision on which competing specialists are allowed to participate in those networks.
3. Specialists may present significant challenges to the geographic markets of ACOs. Physician collaboration is one of several points complicating ACO guidelines. Since there are fewer specialists than primary care physicians, specialists could easily manipulate the market if they align with only one ACO. Also, each separate market must be defined by each specialty, but there are disparities between them. Cardiac surgeons often compete in broader geographic markets than obstetricians, for instance.
4. Miscommunication between primary care physicians and specialists may be a barrier to the integrated care of ACOs. Perceptions on whether the information was transmitted differ between those who sent it and those who received it, according to a study by researchers at the Center for Studying Health System Change. While more than 69 percent of primary care physicians said they always or mostly sent the patient's history to the specialist, fewer than 35 percent of specialists reported they always or mostly received the information. And while 80 percent of specialists said they always or mostly sent consultation results to the referring PCP, but only 62 percent of PCPs said they received the information.
5. Specialists may be crucial to the reduction of readmissions and unnecessary care. The best way for hospitals to profit under ACO principles is by keeping people healthy, and hospitals need to have the efficiencies necessary to offer the best quality and results at a low cost. This requires hospital-physician relationships to become more cooperative. Hospitals need to put effort into their recruitment of specialists, who can assist primary care delivery by ensuring the right diagnosis the first time, says Timothy Hobbs, MD, CEO of Community Physicians of Indiana in Indianapolis. Dr. Hobbs, who oversees a physician group consisting of more than 200 physicians in more than 70 practices, says specialists help eliminate misdiagnosis and unnecessary care.
Read more about ACOs and physician integration:
- 7 Observations on the Queens County Medical Association's All-Physician ACO
- 10 Recently Launched ACOs
- 6 Ways for Community Hospitals to Align with Physicians in Competitive Markets