Health System Consolidation and ACOs

Get physicians on board with risk

The drive for greater market share has sparked unprecedented consolidation among hospitals, hospital systems and physician groups in recent years. As systems organize competitively to participate in risk models such as accountable care organizations (ACOs) and bundled payments, the dramatic surge in hospital employment of physicians hasn’t helped ACO success.

In fact, most Medicare ACOs have not met cost targets needed to generate revenue. All too often, hospitals or health systems and their physicians clash over goals, expectations, outcomes and basic communication regarding Alternate Payment Models (APMs). Perhaps the outside experience of a registry working to help organizations meet these goals can be helpful.

Why Fear ACOs?

Physicians and affiliated providers express legitimate concerns about ACOs and other forms of risk. These can include:

  • Losing role as a highly skilled member of a medical team
  • No control over outcomes
  • An increase in administrative work (e.g. more review of reports, more documentation regarding quality processes, etc.)
  • Doubts that savings will ever materialize
  • Embarrassment caused when evaluated against peers
  • Lost power to manage patients based on expertise

For physicians to overcome these obstacles to trusting the health system’s purpose and goals, their concerns must be addressed by a good partnership inside the organization. The worst way to gain their buy-in is for providers to be corralled by nature of their employment and put on the defensive. A contentious, punitive stance by management will not produce the collaborative drive for better results that is essential for success under risk models.

Top Four Priorities to Foster Physician Alignment

1. Provider Involvement

  • Foster community driven by a positive approach to change, rather than one driven by compliance and negativity.
  • Form a physician organization with real physician governance. Encourage your physicians to become informed and be recognized as experts in risk.
  • Create a central location for all physician details (e.g. specialties, residents, EMR/practice management system information for acquired groups, TIN-PIN groupings, etc.) It is impossible to participate in Alternative Payment Models such as ACOs without solid data on practice administration and volume.
  • Know the correct legal and financial structure and understand the physician enterprise. Grasp the implications of basics, such as Tax Identification Number (TIN) and how this matters to all ACO and other physician incentive programs like MIPS. These may seem like inconsequential administrative issues, but such changes can have a big impact on your incentive programs’ success.
  • Recognize how your referrals work—where they come from and your providers’ preferences. Know how providers fit into the whole network of care before you disrupt current arrangements.

2. Aligned Incentives

  • Know what works to bring recognition to physicians and revenue into the practice via physician- and value-based healthcare programs.
  • Create performance measurements that are practitioner-focused:
    • Research Qualified Clinical Data Registries (QCDR) for your PQRS reporting method—they can transform a PQRS effort into an all-patient, cohesive performance measurement strategy that will engage physicians.
    • Establish shared goals for outcomes.
    • Emphasize performance evaluations that inspire and engage providers, rather than trivial or process assessments.
  • Take your performance pulse before you undergo an ACO transformation. One of the key ways to do this is to evaluate your Quality Resource and Use Reports (QRURs).

3. ACOs, other Alternative Payment Models (APMs) and MIPS

  • Avoid ACO “cost savings” based exclusively on approaches such as one-time patient outreach, without addressing real performance improvement interventions.
  • Empower leadership to drive performance initiatives by requesting provider participation in goal setting, review of data and forming performance improvement projects.
  • Concentrate performance on positive, not only negative results. What works and what could be improved upon? Seeking out the underperformers is not the right approach to physicians and will ultimately block progress.
  • Impartially attain information from patients to evaluate outcomes, functionality, and patient choices. Share those results with providers.

4. Beyond Traditional Approaches

  • Foster communication and collaboration between physicians and their patients, helping them to incorporate patient goals in treatment plans. Since patient cooperation is another part of the results equation, think about how to assist physicians in embracing the “new” culture of patients who will not accept an authoritarian approach to their health, but seek understanding and participation in clinical treatment plans.
  • Structure intensive case management by supporting practices, not replacing them. Physicians are very sensitive to outside communication with their patients.
  • Collaborate with external experts and build knowledge to expand your database for comparison, by employing a Clinical Data Registry to help you instate performance improvement initiatives that test the effectiveness of your interventions as well as compare you with other health systems.
  • Take advantage of Specialized Registry reporting under Meaningful Use Modified Stage 2, to give you access to bench-marking and comparisons with others.

About The Author

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