Physicians’ practices are once again facing proposed new payment systems and structures. Now it’s Accountable Care Organizations (ACOs), and it’s the ‘acronym wars’ all over again. Doctors are left to wonder what changes will be made to reimbursements – and what new oversights will be placed on them.
There is no shortage of opinions on the best way to prepare your practice. Should you sell your practice to the hospital or become a member of a large group? Should you join an ACO? If you’re a specialist, should you join two ACOs?
The ACO is the newest model that stresses clinical integration among providers. ACOs spring from the Affordable Care Act, and they are based on the concept of participating in “shared savings.” But this is not a new idea. Remember the first HMOs? They were all about capitated payments and risk pools, and they promised to answer the big question that has dogged payers, providers, and society as a whole: How do we reduce costs while maintaining quality at the same time?
Intuitively, capitation sounds like the perfect solution: Pay physicians a fixed amount of money to care for a given population of patients. If doctors can keep those patients healthy, the rationale went, they share in the money saved (because they see the patients less frequently) and costs will go down. Suddenly, doctors are incentivized to provide the appropriate amount of care.
But what if doctors get greedy and withhold care instead? The pendulum has swung from overutilization to underutilization. Ok, scrap that idea because costs are still going up. Now what?
Clinically integrated ACOs promise to address this dilemma, and they could have hundreds of doctors plus professional management in the ranks. ACOs might remind us of the capitated payment models of the past, like Physician-Hospital Organizations (PHOs) and the single-specialty capitated networks that were once popular. But the structures and the governance of ACOs are better, stronger, faster – built upon our experiences from the ‘80s, ‘90s, and 2000s. Those who forget history are doomed to repeat it, right?
Still, there is the trust issue. Doctors aren’t sure they can trust these new structures, and they still have problems trusting one another. Payers still want quality assurance and utilization review in place. Patients are nervous about access.
If you’ve been a physician practicing for just a few years, or if you’ve been seeing patients since the ‘80s, you know that the pressure on your reimbursements has been unrelenting. Are ACOs the “new” new answer?
To hear perspectives from each corner of the debate, plan to attend the upcoming conference, “Time for Tough Choices at Your Practice – Learn how your revenues will be impacted by changing times: ACOs, Clinical Integration, Hospitals, Contracting, and Your Future”, scheduled for September 15th at the Sheraton Fort Lauderdale Airport Hotel. This one-day event includes several industry-leading experts (all of whom are dynamic and entertaining speakers). The cost is $69, and you can register by going to www.bcma.com or emailing cpeterson@bcma.com.
The conference is being produced by a new group of seasoned healthcare professionals who are aiming to fill the physicians’ knowledge gap. Known as The Health Care Solutions Alliance (HCSA), this group includes attorneys, accountants, consultants, and others who each have 20+ years of experience in the healthcare system working with and advising medical practices.
Want to know more about the event? Email BFoster@carecloud.com for more information!
Brian Foster is a Director of Client Solutions at CareCloud with over 20+ years in the healthcare industry. Throughout the 1990s he was the Publisher of a specialized trade paper for healthcare industry professionals. Since 2001, Brian has worked as a senior business development professional, helping medical practices to provide the highest-quality patient care while simultaneously improving revenues. He can be reached at BFoster@carecloud.com or (786) 879-9200.
