The number of accountable care organizations (ACOs) in the country is growing rapidly, as is the number of practices approached about participating in them. If your practice is approached, will it be prepared to make a smart decision?
While ACO participation could result in financial gains, it could also lead to financial losses for your practice. That’s because ACO participants (medical groups, practices, hospitals) partner to improve care quality while reducing care costs for a specific patient population, such as Medicare patients. If successful, ACOs share in a portion of the cost savings, if not and depending on the risk/reward structure of the ACO, participants share in a portion of the losses.
Here are some ways to determine if your practice is ready to take on that risk:
1. Assess your practice. One of the first ways to determine if an ACO is right for your practice is by conducting an “honest self-assessment,” internal
medicine physician Charles Kennedy, chief executive officer of Aetna Accountable Care Solutions, recently told Physicians Practice.
“In order to be successful in an ACO you have to start with a good understanding of your current ways of operating,” said Kennedy, who is a presenter at the HIMSS13 conference in New Orleans. “In other words, do you have experience with risk-based contracts? Do your physicians practice in a way that is more consistent with high-quality high-value healthcare or do they practice in a way that is more consistent with fee-for-volume ways of practicing?”
If not, you may struggle if you jump into full-fledged ACO participation, he said.
2. Assess your potential partner(s). Also consider whether your potential ACO partner, such as the hospital or health system that has approached you about participating, is right for your practice. “There are some hospitals that are seeking clinical integration strategies and trying to acquire practices less because they believe in accountable care and more because they are doing it for contracting leverage and self sustainability,” said Kennedy. “... Their strategy implicitly becomes your strategy, and not every hospital or health system that tries to do this is going to be successful.”
Before agreeing to participate in an ACO, spend time with hospital leadership to gauge their ACO goals, strategy, and funding, and make sure those things align with your needs and vision, said Kennedy.
Keep in mind that there may be some ways to begin to take on more risk-based reimbursement without transitioning to full-fledged ACO participation. For instance, some managed care plans are recruiting medical groups and IPAs into forming ACO-type arrangements that carry less financial risk, said Kennedy. That’s a way to “put your toe in the water so to speak with accountable care, but not have as much at risk and not have to make substantial investment.”
3. Assess your environment. Still, a gradual approach to ACO participation may not be the best move for some practices, especially those that have prior risk-based contract experience and are likely to be successful in an ACO. The Medicare Shared Savings Program, for instance, offers ACO participants that take on more risk the potential to share in a significant portion of cost savings.“...These programs probably aren’t going to be as good as they are forever,” said Kennedy.
There are other reasons why putting off ACO participation could hold your practice back in the long run. “Many physicians believe they can continue on in fee-for-service medicine and see where ACOs go,” said Kennedy. “I believe that if ACOs are successful, and [practices] aren’t part of the early wave, they could find themselves locked out of the resulting healthcare system, which could be very damaging to their long-term viability...”
For more tips on how to determine if your practice is ACO-ready, use this checklist provided by Aetna Accountable Care Solutions.
Kennedy will be presenting at HIMSS13 during the Tuesday, March 5 session, Lessons/Insights from a Pioneer ACO’s Journey to Value-Based Care.