Primary-Care Physicians Key to ACO Formation, But Resistant

July 29, 2011
Aubrey Westgate

Primary-care providers are in a unique position of strength in the world of healthcare. That’s because they are both the obstacle and the gateway to ACOs.

Primary-care providers are in a unique position of strength in the world of healthcare. That’s because they are both the obstacle and the gateway to ACO formation.

According to the CMS- issued proposed rules for ACOs - in which groups of physicians and hospitals will be held jointly accountable for cost and quality of patient care - at least one primary-care provider must participate in each group.

That’s leaving healthcare organizations and hospitals interested in forming ACOs scrambling to court, befriend, and acquire these physicians.

In addition, those healthcare organizations already affiliated with primary-care providers are working hard to convince them that ACO participation is beneficial.

Neither task is easy for those larger healthcare organizations.

A recent survey conducted by healthcare staffing and management firm AMN Healthcare found that physician alignment is the biggest roadblock to ACO formation.

The firm asked 882 physicians and health facility administrators about ACOs. Of those surveyed, 42 percent said they would not be forming an ACO. And of that 42 percent, 40 percent cited lack of physician alignment as the reason.

Why are physicians so hesitant to participate in the ACO program?

Independent physicians are, of course, fearful that joining a group will decrease their independence and autonomy.

Other providers, including those already affiliated with larger healthcare organizations, are skeptical that ACO participation will benefit them.

In fact, 41 percent of the AMN study participants said they strongly disagree or somewhat disagree that ACOs will deliver significant cost and quality benefits over time; and said they disagree that ACOs will enhance quality and reduce costs.

As a result, instead of jumping right into the ACO program, it seems that many physicians would rather adopt a “wait and see” approach when it comes to joining ACOs - something practice notes blogger and family physician J. Scott Litton wrote about recently.

“At this point, I will cautiously watch the events to transpire over the remaining months in the year and will very likely continue to assume a 'wait and see' approach,” he wrote. “In order for the ACO model to be a success for me it must prove to be helpful for me in delivering care for my patients, it must not place any excessive barriers for caring for my patients, and it must lead to better outcomes.”

Despite the resistance from primary-care providers, it’s estimated that 100 ACOs will be up and running in January 2012. Within the next three years, that number is expected to skyrocket to between 500 and 1,000, the director of Dartmouth's Center for Health Policy Research Elliott Fisher told USA Today.

"There's broad agreement that the trajectory of the U.S. healthcare system is unsustainable," Fisher said. "I think that almost every provider group, every physician, recognizes that change is coming."