According to a recent study published on Wiley Online Library, 60% of physician practices have not joined and have no intention of joining an ACO in the future. Recently, I was involved in a twitter discussion asking me why I am not planning on joining an ACO. The major reason is that they haven’t proven successful. Of the 32 medicare pioneer ACO’s : 9 dropped out, 13 had “some” savings, and 2 lost money and had to pay CMS. The ones that had “some” savings did not necessarily have enough to get paid. Of the 114 Medicare SSP ACO’s: 54 “saved” money but not enough to get paid. Only 29 generated enough savings to get paid. Clearly, not a successful track record in any professional’s book. Some may argue that there have been ACO’s that have been successful in certain markets. But, when Medicare’s ACOs are blatantly unsuccessful, it gives little confidence for physicians to rush out and sign a commitment to an organization that may fail.
There are many reasons that doctors are not rushing to join ACO’s:
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1. As noted above, this is a new venture and may very well fail. There is no record to study to make a wise investment.
2. We are only allowed to join one. We are not allowed to change once we sign up. What if we choose the wrong one?
3. It is another intrusion into the way we practice. We are now required to meet increasing government regulations, ie meaningful use, e-prescribing, etc. This is another way for insurers to regulate the way we practice.
4. We can lose money. Most doctors are truly trying to give the best care for our patients. We try to be cost conscious about it. We are the ones on the front lines who know the patient best and can make the best treatment decisions. We do not need an organization to hold us accountable for costs. Some patients are truly sick and require expensive diagnostic work up. I don’t want to have it in the back of my mind that I may get “dinged” for ordering an expensive test that I think a patient needs. For doctors, quality comes first. Sure, we all need to take some responsibility for holding down costs, but I fear the day when we are punished for doing the best for our patients.
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5. Most ACO’s are not physician run. The quality measures are being made by non-physicians. Quality metrics can only be determined by someone who has a medical degree. If others are determining what makes up good outcomes, they are basing their decisions on statistics and not medicine. Clearly, a deficiency in my mind.
6 The future is uncertain. With the passage of the ACA, many physicians are concerned about the future of the healthcare system in this country. Many fear the worst. Many are in a “wait and see” position before making any decisions about changing the way they practice.
7. Doctors have been burned by insurance companies and regulations in the past. Most are not trusting the new ACOs based on past experiences.
These are some of the many reasons that this country’s doctors are not rushing to embrace ACOs. Unless they prove themselves successful and trustworthy, I doubt this will change much.
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter's University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions. Dr. Girgis earned her medical degree from St. George's University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year. She is a blogger for Physician's Weekly and MedicalPractice Insider as well as a guest columnist for HIT Outcomes. She has had articles published in several other media outlets. She is on the medical advisory board of SERMO. Recently, she has authored the book, “Inside Our Broken Healthcare System” and "The War on Doctors". She has been interviewed in US News and on NBC Nightly News.
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