Accountable Care Organizations are the hot topic in healthcare right now. Along with Repertoire and its sister publications The Journal of Healthcare Contracting and First Impressions, MDSI is also producing ACO Insights to provide news and analysis on ACOs. We recently interviewed American Medical Association President, Dr. Cecil Wilson, and he had some interesting things to say regarding ACOs and physicians. Here were some notable quotes:

“The reality is, if accountable care organizations are going to work throughout the country, they have to take into account the fact that 78 percent of office space physicians work in practices of nine or less, and a majority of those are in solo, or groups of two to four physicians,” says Wilson. “To make ACOs work, you’re going to have to find a way with those physicians, who represent a majority of physicians in the country, to be able to work together to share information about quality and continuity of care to make ACOs work, to drive improvements in quality as well as cost.”

Wilson says in talking with individual physicians around the country, their chief concern is that “hospitals will dominate ACOs to the detriment of physicians and patients. Part of that is because this is something that’s already occurring,” he says. “Even before the Affordable Care Act was passed, around the country hospitals have been buying up physician practices and running those practices and it’s probably the economics of medical care. The Affordable Care Act is providing a stimulus for that to continue. Our physicians have great concerns about that.”

Wilson says putting together an organization like an ACO is going to require an upfront cost and ongoing cost and resources, and a lot of small practice physicians are in short supply of the capital needed. “Physicians in small groups now and in the last several years, when every year they’re threatened with cuts in Medicare, and Medicare payments have not kept up with the cost of providing, physicians do not have the resources to in essence form a new business,” says Wilson. “So we’ve suggested to CMS, and did this at recent rollout for CMS innovation, one of the things that CMS innovation might well do is use some of the funding they have in the form of grants to provide the startup costs for ACOs that would get over the hurdle of financing.”

Wilson says it’s important for physicians and patients that these ACOs, whatever their model, size, risk and reward for the participants, should be voluntary in nature. “There should not be a requirement that one do something only a certain way,” he says. “That stifles innovation, creativity, limit the options for doing things a different way. We think that to make it mandatory that a physician practice only in a certain mode is just antithetical to the American way. We (Americans) believe in encouraging individuality, creativity, and the ability to do things in a lot of different ways.”

 

To read the full article on the AMA’s take on ACOs, click here

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