Here are 10 considerations and facts about accountable care organizations for spine surgeons considering whether to participate in one.
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1. Time will tell whether joining an accountable care organization is a smart move, but spine surgeons have several options. They can participate in an ACO, partner with ACO providers without direct participation or remain outside of the ACO. "Aligning with a medical group or a hospital ACO including a medical group would be extremely beneficial as the new structures are forming," said A. Nick Shamie, MD, associate professor of spine surgery at UCLA and president of the American College of Spine Surgery in a Becker's Spine Review report. "This is especially true to busy, competitive markets, such as in big cities where hospitals are purchasing physician practices."
2. Benefits for the physicians who participate in ACOs include increased care coordination, improved evidence-based medicine with disease protocol, improved office workflow efficiencies and ease of access to key clinical information, according to the Medicity report.
3. The Medicare program offers three types of ACOs:
• Medicare Shared Savings Program
• Advanced Payment ACO Model
• Pioneer ACO Model (this program is no longer accepting applicants)
Additional payment models with private insurers include:
• One-sided shared savings
• Two-sided shared savings
• Bundles/episode payments
• Partial capitation/global payments
• Global payments
Orthopedic surgeons are more comfortable with Medicare as the ACO payer than private payers, but 61 percent would rather not participate in ACOs at all, according to the Annual Compensation and Employment Survey.
4. Physicians can participate in ACOs, though many current programs are hospital-driven. The ACO targets multispecialty group practices, independent practice associations and networks of individual physician offices that partner with hospitals, according to a Medicity report. However, physician-sponsored ACOs doubled between October 2011 and May 2012 to 32 percent of all ACOs, according to a Beryl Health ACO infographic.
Physicians do not have to participate in an ACO at this point. Some spine surgeons are concerned that hospital-directed ACOs won't compensate physician participants fairly and are weary of joining such arrangements, according to a Becker's Spine Review report.
5. Commercial payers are interested in ACOs and shared savings programs, and some plan to partner with physician groups and hospitals to launch ACOs without waiting for the long-term results of the Medicare pilot program, according to the Medicity report. The program was projected to save $940 million in the first four years, according to the Beryl Health ACO infographic.
6. Accountable care organizations are looking for groups that can provide all-inclusive care for the patient. If your group includes non-operative treatment, imaging and other ancillary services to treat the entire back pain patient, you'll be in a unique position to direct patient care with the ACO.
7. Around 67 percent of the physicians involved in ACOs during 2012 reported they did not see personal financial benefits from their participation. Only 14 percent said they did see financial returns, according to Jackson Healthcare's 2013 Physician Outlook & Practice Trends survey.
8. Among orthopedic surgeons, 26 percent say ACOs will cause a slight decrease in income while another 38 percent said they will cause a large income decrease, according to the Medscape Orthopedist and Orthopedic Surgeon Compensation Report: 2012. However, only about 2 percent of orthopedists reported ACO participation with only 5 percent more planning to join an ACO in 2013.
9. According to a report by Oliver Wyman, about half of the United States population lives in areas served by ACOs, with 52 percent of patients living in primary care service areas served by ACOs. ACOs now cover 37 million to 43 million Medicare and non-Medicare patients.
10. After the first year, 32 members of the Medicare Pioneer ACO Model were able to improve quality and patient satisfaction. However, 12 did not achieve significant savings and seven dropped out of the program.
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